Heritage Residential Care 2

Type of visit: Required - 1 Year

On 12/11/2025, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced 1-year required visit at the facility. LPA met with Licensee Maria Undan and explained to Maria the purpose of LPA's visit. LPA was granted entry and conducted a tour of the facility. LPA observed the following during the visit: The facility is a two-story structure which consisted of (2) two resident bedrooms, (4) four family bedrooms (2) two bathroom, garage, formal dining room, living room, kitchen, and backyard. The backyard was equipped with a covered patio that was furnished. Indoor/Outdoor passageways were free from obstruction. The kitchen was kept free of litter and vermin. LPA observed a locked file cabinet located in the kitchen which housed knives, sharp objects, and disinfectants. The facility met the required (2) two-day supply of perishable foods and (7) seven-day supply of non-perishable foods. Resident bedrooms were shared but did not hold more than two residents per shared bedroom. The residents bedrooms were equipped the the required bedding, furniture, and functional lighting. Bathrooms were equipped with the required grab bars and slip resistant mats. LPA observed a fully charge fire extinguisher mounted on the wall in the hallway. Medication is centrally stored and is inaccessible to residents. The dual smoke and carbon monoxide detectors was tested and was observed to be fully operable. Per Licensee, there are no firearms and/or ammunition on the premises. LPA observed the following required postings during the visit: See Something Say Something, facility license, Administrator Certification, LTCO, facility sketch, Infection control plan, and LIC500. LPA did not observe any health and safety concerns. Resident records review included but not limited to preplacement appraisals, admission agreements, re-appraisals, dental, physician reports, and needs and service plans. Staff records included but not limited to health screening, background clearance, personnel record, SOC341A, valid First-Aid/CPR Certification, and relevant training's. An exit interview was conducted and a copy of this report was provided to the Licensee, Maria Undan.the state’s words, verbatim · CDSS document, Dec 11, 2025

Allegation investigated: Staff have a language/communication barrier.

On 10/6/2025, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of delivering findings into the allegation listed above. LPA met with Licensee, Maria Undan, and explained to Maria the purpose of the visit. The investigation consisted of observations and interviews. Information received alleged Staff #1 (S1) has a language/communication barrier which may impact the quality of care provided to the residents. Interviews conducted with staff and residents corroborated that S1 and all care staff associated to the facility, speak English and was reported that residents do not have a difficult time understanding staff and/or speaking with staff. Interviews with staff and residents, further corroborated that staff speak with residents on a regularly basis and residents care needs are being met. LPA conducted auditory observation during an interview with S1. LPA observed S1 fully able to communicate clearly and effectively. (Continue to LIC9099C..) Unfounded (Continuation from LIC9099) S1 was observed to display a good understanding and fluency of spoken English. Based on interviews and observations, the allegation is deemed Unfounded at this time. A finding of Unfounded means that the allegation is either false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted, where a copy of this report, LIC811-Confidential names list, was reviewed and provided to the Licensee, Maria Undan.the state’s words, verbatim · CDSS document, Oct 6, 2025 · control 18-AS-20250924094858

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction and visit purpose. Upon arrival LPA learned that four (4) residents live at this facility. There was two (2) staff members present. The Administrator, Maria Araceli Undan was advised of the annual conducted and completed the facility tour. Client Records/Incident Reports/Clients Rights Information: LPA reviewed client records. Four (4) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. Personnel Records/Training/ Staffing/ Administration: LPA reviewed employee records. Two (2) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrative organization. Maria Araceli Undan, Administrator’s certificate expiration date was 10/18/2025. Food Service: Food prep areas are clean and organized. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a location for sharps in the kitchen. Physical Plant and Safety of Environment/Operational Requirements: LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility is maintained at 75 degrees for the client’s comfort. Lighting is sufficient for safety. Water temperature measured 108.0 degrees F. Laundry is done in the laundry room. There is a locked location for storing laundry soap, cleaning supplies and chemicals in the closet where laundry is done. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. LPA dialed the facility’s landline number, which rang and was operable. The LIC 610, emergency disaster plan is maintained. There are no firearms at this facility. There is one (1) secured fireplace at this facility. There are zero (0) pools at the facility. There is two (2) secured gate that has a self-latching lock located in the front and northwest side of the house. LPA observed emergency supplies and one (1) first aid kit. The last emergency fire drill was conducted on 07/15/2024. Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements. LPA reviewed staff records and found that staff had infection control training. Medications/Health Related Services/Incidental Medical Services: The medications are centrally stored. There is a locked cabinet allocated for medication storage. Centrally stored medication and destruction logs are maintained separately. LPA reviewed medication logs and observed that they were dispensed accurately. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. LPA observed seven (7) smoke detectors and one (1) carbon monoxide detectors throughout the facility. There were one (1) fire extinguishers on site, date charged was 09/26/2024. Pursuant to Title 22 of The California Code of Regulations Division 6, there are zero (0) deficiencies observed. An exit interview was conducted, this LIC 809 was reviewed with, and a copy of this report was provided to the Administrator, Maria Araceli Undan.the state’s words, verbatim · CDSS document, Sep 27, 2024