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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608079
Report Date: 02/07/2023
Date Signed: 02/07/2023 03:10:03 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/07/2023 03:10 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:HEIGHTS SENIOR CARE, THEFACILITY NUMBER:
197608079
ADMINISTRATOR:SAYDA NAZ HAIFACILITY TYPE:
740
ADDRESS:690 PICAACHO DRIVETELEPHONE:
(562) 228-3063
CITY:LA HABRA HEIGHTSSTATE: CAZIP CODE:
90631
CAPACITY:6CENSUS: 3DATE:
02/07/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
02:18 PM
MET WITH:Sayda HaiTIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Christine Wong conducted an Annual/Required site visit on 02/02/2023 and has returned on this date 02/07/2023 to conduct an Annual continuation visit. LPA met with administrator Sayda Hai who allowed the entry to the facility and assisted with the visit. On today's visit, LPA used the infection control tool to evaluate the facility, reviewed Staff files and residents' medication.

LPA reviewed 2 residents medication and they all seemed accurate and up-to-dated. LPA also review 2 staff files and they all have background check cleared and their health screening are all updated on the personnel files.

Facility is currently following COVID 19 recommendations regarding COVID 19 signs throughout the facility, The facility is disinfected at least once a day. Resident's bathrooms have sufficient soap, paper towels, and signs. Facility has sufficient PPE supplies for at least 30 days supply.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies therefore no citations were issued at this time.

An exit interview was conducted and a copy of the Report was provided to Administrator Sayda Hai .
SUPERVISOR'S NAME: David SicairosTELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine WongTELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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