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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366413073
Report Date: 12/13/2024
Date Signed: 12/13/2024 11:47:24 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/09/2024 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20241209081724
FACILITY NAME:HERITAGE COURT ASSISTED LIVINGFACILITY NUMBER:
366413073
ADMINISTRATOR:SCHLOTTMAN, JACOBFACILITY TYPE:
740
ADDRESS:275 GARNET WAY BTELEPHONE:
(909) 204-5000
CITY:UPLANDSTATE: CAZIP CODE:
91786
CAPACITY:88CENSUS: DATE:
12/13/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ricardo LaraTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff do not ensure that residents have hot water.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to initiate and deliver the findings for the above allegation. LPA met with Facility Administrator Ricardo Lara who was informed of the purpose of the visit and the allegation listed above. The investigation consists of, records review, and interviews regarding the above allegation.

First Allegation: Staff do not ensure that residents have hot water. Regarding the allegation “Staff do not ensure that residents have hot water” On 12/9/2024 LPA received a phone call by resident #1 informing that facility has not had hot water for a few days. On 12/9/2024 LPA contacted facility and spoke with Facility Maintenance Supervisor who confirmed that facility did not have hot water due to a water heater issue however, Maintenance Supervisor inform LPA that a service request was implemented, and that the facility is currently working on fixing the hot water concern. On 12/13/2024, LPA inspected Room (119, 120, 117, 122, 114, 108, 2nd floor 220, 213, 210), and discovered that all listed rooms had hot water.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 56-AS-20241209081724
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: HERITAGE COURT ASSISTED LIVING
FACILITY NUMBER: 366413073
VISIT DATE: 12/13/2024
NARRATIVE
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LPA conducted interviews with four residents R#1 informed LPA that facility did not have hot running water for a few days however, hot water came on Monday 12/9/2024 at 9pm and it went off and came back again. R#1 informed LPA that facility did not announce the hot water issues or provided residents with other accommodations. R#2 and R#3 informed LPA that they were not aware that facility did not have hot running water and showered with cold water. R#4 informed LPA that facility did not have hot water and at one point facility completely shut off the water. LPA conducted a record review and discovered that the facility submitted a service request on 12/6/2024, regarding the on and off issue concerning the hot water. Facility administrator informed LPA that the facility had on and off water however, alternative accommodations were not provided for residents to accommodate their bathing needs. Based on the evidence along with the observation, the above allegation Substantiated.

Substantiated: A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Title 22 regulations, 87303 Maintenance and Operation, from division 6, chapter, article 6, is being cited on the attached LIC 9099 D.

An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided, along with a copy of the appeal rights. to Facility Administrator Ricardo Lara.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20241209081724
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: HERITAGE COURT ASSISTED LIVING
FACILITY NUMBER: 366413073
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/17/2024
Section Cited
CCR
87303
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Maintenance and Operation .... (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors..... (6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or nonambulatory residents, based on the residents' needs.
This requirement is not met as evidence by:
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Facility Administrator provided LPA with completed work order invoice. LPA confirmed facility had running hot water. POC was cleared on the same day of visit 12/13/2024. LPA gave extra time on cleared date to ensure facility water heater did not have any reoccurring issues.
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Based on interviews, record review, the Administrator/licensee did not ensure hot water or hot water accommodations were provided to residents, which poses a potential Health, Safe, or Personal Rights risk to persons in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3