Heritage Residential Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Licensee Maria Undan. The facility's license shows a maximum capacity of six (6) non-ambulatory residents, of whom one (1) may be bedridden in Bedroom #3. Hospice waiver for two (2). During today’s inspection there were five (5) residents in care. LPA with Licensee Undan toured the interior and exterior of the facility and inspected each room. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. In Resident #1 (R1)’s bedroom LPA observed a trash can without a cover that contained used gloves. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Licensee Udan, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced within the last 12 months. First aid kits were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. [CONTINUED ON LIC809-C] LPA reviewed facility records. Review of staff records revealed that Staff #1 (S1) did not have current cardiopulmonary resuscitation (CPR) training and first aid training. Review of staff schedule revealed that S1 was the only staff on duty and on the premises during their shifts. Confidential records were stored in locked areas. Two deficiencies were cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D). A plan of correction was jointly formulated, and an exit interview was conducted with Licensee Undan, to whom a copy of this report, LIC809-C, LIC809-D and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to.the state’s words, verbatim · CDSS document, Nov 24, 2025

Allegation investigated: Staff did not ensure that resident was adequately fed. Staff did not meet resident's grooming needs.

On 5/16/2025 at 9:30 AM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to deliver the findings of the above allegations. LPA Serrano met with Administrator Maria Araceli Undan to explain the purpose of the visit. The investigation consisted of file review, interviews with facility staffs and residents as well as facility observation. Allegation #1: Staff did not ensure that resident was adequately fed.– Based on interviews 3 out 3 residents stated that they get enough food to fill them up and if they want more food, they can always ask for more. The residents stated that they were never denied food if they want to eat. Also, information received indicated that resident #1 (R1) was receiving additional services from an outside source from at least 7/07/2023 through 10/27/2023. Information received during investigation did not corroborate with the allegation. *** Continuation in LIC9099C *** Unsubstantiated Allegation #2: Staff did not meet resident's grooming needs. - Based on interviews 3 out of 3 residents stated that the facility staff helped them with showers and grooming. The residents stated that they have schedule and have no issues if help is needed. Also, information received indicated that resident #1 (R1) was receiving additional services from an outside source from at least 7/07/2023 through 10/27/2023. These services included showers and wound care. Information received during investigation did not corroborate that R1s grooming needs were not being met. During the investigation, LPA did not find evidence to corroborate the allegations. Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time. An exit interview was conducted where this report, LIC9099 and LIC9099C were discussed and provided to Administrator Maria Araceli Undan.the state’s words, verbatim · CDSS document, May 16, 2025 · control 56-AS-20231030124204

Type of visit: Required - 1 Year

On 11/20/2024 at 09:08 AM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Brown met with a staff and was granted entry to the facility. Licensee/Administrator Maria Araceli Undan was contacted and informed of the visit. Licensee/Administrator Undan arrived at the facility during the visit. At the time of the visit there were two (2) staff present, and six (6) residents present. The facility is a four (4) bedroom, two (2) bathroom home with a kitchen/dining area, living room/activity room and laundry room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) non-ambulatory residents of which one (1) may be bedridden. The facility’s approved for two (2) hospice waiver. The current census is six (6) residents. LPA Brown was accompanied by Staff #2 (S2) to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor passageways. However, LPA Brown observed outdoor passageways not free of obstruction. Deficiency will be issued. The facility is maintained at a comfortable temperature of 75 degrees Fahrenheit. LPA Brown inspected resident bedrooms; they are equipped with mattresses, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA Brown observed sufficient lighting throughout the facility. However, LPA Brown observed missing one (1) night stand on Room #3 and missing chairs on all resident rooms. Technical Violation will be issued. LPA Brown measured and observed the water temperature in the bathroom to be at 98.9 degrees Fahrenheit. Deficiency will be issued. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguisher was also observed at the facility. Posters such as personal rights, the CCLD complaint poster, ombudsman poster, and the disaster plan were posted in a common area. During the tour of the facility, LPA Brown observed one (1) window screen in disrepair. Technical Violation will be issued. ***Continuation in LIC809C *** In addition, LPA Brown observed Resident #4 (R4) with half bed rail and per staff interview and records review, R4 does not have written order from R4 physician indicating the need for half bed rail for mobility. Deficiency will be issued. Also, LPA Brown observed no night lights maintained in hallways and passages to non-private bathrooms. Deficiency will be issued. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine Cabinet with the resident’s medications locked. LPA Brown observed a complete first aid kit and first aid book at the facility. However, LPA Brown observed the facility does not have the required emergency supplies, food and water. Deficiency will be issued. Food Service: More than seven (7) days’ supply of Non-perishable foods and more than two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. Care & Supervision: The facility has an Administrator present at the facility with appropriate and enough hours to appropriately manage the facility. However, based on staff interview and records review, LPA Brown observed no night staff scheduled to work the night shift, awake and on duty, not sleeping at the same time as the residents as required for facility with dementia residents. Deficiency will be issued. Record Review: LPA Brown observed the facility has an updated Liability Insurance. However, LPA Brown observed no Infection Control Plan developed by the Licensee at the facility. Deficiency will be issued. LPA Brown reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisals, centrally stored medication list and needs and services plans. LPA Brown observed no pre-admission appraisal completed for Resident #1 (R1) and Resident #3 (R3) and Resident #2 (R2) pre-admission appraisal does not have the required R2's responsible person signature. Deficiency will be issued. Also, LPA Brown observed no completed Preplacement Needs and Services Plan for Resident #2 (R2). Deficiency will be issued. LPA Brown reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test result. LPA Brown observed that files reviewed were complete. Per records review, LPA Brown observed that the facility were issued the same deficiency for CCR 87303 Maintenance & Operation (e)(2) and HSC1569.695 Other Provisions (e)(2) on 12/28/2023 therefore ***Continuation. in LIC809C*** civil penalty of $250.00 per violation will be issued today, 11/20/2024 for repeating the same violation within 12-month period and will continue to be assessed of $100.00 per day until corrected. Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC809D, LIC9102TV, LIC421FC and Appeal Rights were discussed and provided to Licensee/Administrator Maria Araceli Undan.the state’s words, verbatim · CDSS document, Nov 20, 2024

The state marks this report as 13 pages; the online copy we transcribed has 8. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Caregiver Alexander Angulo and was granted entry to the facility. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for a capacity of six (6) non-ambulatory residents, one (1) resident may be bedridden. The current census is five (5) residents. LPA was accompanied by Caregiver to conduct a general overall inspection, which included, but was not limited to, the following: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to interior and exterior passageways. The facility is maintained at a comfortable temperature. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA measured and observed the water temperature in the bathrooms to be at 129.3 degrees F. The facility will be issued a deficiency for not having the water temperature within the correct temperature range. LPA observed sufficient furniture and lighting throughout the facility. The facility has residents with a condition that requires auditory devices on the facility exit doors. The facility does not have working auditory devices on the exit doors in the living room, laundry room, staff room #1, bedroom #2, and bedroom #3. The facility will be issued a deficiency for not having auditory alarms on the facility exit doors. LPA found holes in the ceiling and the wall covered with trash bags and tape in the staff room #1. LPA found holes in the ceiling in the laundry room covered with trash bags and tape. LPA was informed by the Administrator that the holes were made in the wall and ceiling to add fire sprinklers, but the Administrator has since decided not to complete the addition of the fire sprinklers. The facility will be issued a deficiency for having holes in the walls and the ceiling. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Postings such as the facility license, personal rights, and the CCL complaint poster were posted in a common area. The facility does not have disaster plan, LIC610E posted, and the facility has not conducted a disaster drill since 1/10/2021. LPA was informed by the Administrator that they knew they did not conduct a recent disaster drill or have a disaster plan posted in the facility. The facility will be issued deficiencies for not posting a disaster plan and for not conducting a disaster drill quarterly. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident and staff files. Medications are kept inside the hallway cabinet inaccessible to residents. Non-perishable and perishable food supply is sufficient for the residents in care. Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. LPA reviewed six (6) residents files for admission agreements, updated physician reports, and needs and services plans. LPA found that Resident’s R1, R2, R4, and R5 do not have needs and services plans, LIC625. The facility will be issued a deficiency for not having needs and service plans for the residents. LPA reviewed three (3) staff files for First Aid/CPR certifications, criminal record clearances, trainings, and health screenings. Based on the observations made during today’s visit, six (6) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC809D forms, and LIC811 were discussed and provided to Caregiver Alexander Angulo, along with a copy of the appeal rights.the state’s words, verbatim · CDSS document, Dec 28, 2023