197608079-12-19-2023-28-AS-FFIS-CYYVZ8-20231229155219

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608079
Report Date: 12/19/2023
Date Signed: 12/19/2023 04:47:56 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/15/2023 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20231215112346

FACILITY NAME:	HEIGHTS SENIOR CARE, THE		FACILITY NUMBER:	197608079
ADMINISTRATOR:	SAYDA NAZ HAI		FACILITY TYPE:	740
ADDRESS:	690 PICAACHO DRIVE		TELEPHONE:	(562) 228-3063
CITY:	LA HABRA HEIGHTS	STATE: CA	ZIP CODE:	90631
CAPACITY:	6	CENSUS: 4	DATE:	12/19/2023
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Sayda Naz Hai, Licensee		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff did not administer prescribed medication to a resident in care.
Facility illegally evicted a resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted an unannounced initial complaint visit to the facility regarding the above-mentioned allegations. Upon arrival at the facility, LPA met Sayda Naz Hai, Administrator and explained the purpose of today’s visit.

The investigation consisted of interviews of staff from staff #1 (S1) through staff #2 (S2); interviews of resident#2 (R2) and resident#3 (R3); attempted interview of resident#1 (R1), resident#4 (R4) and resident#5 (R5); interview of R1’s representative (RR); review of resident#1 (R1)’s record; and tour of the facility. LPA obtained copies of the staff and resident rosters, and resident #1 (R1)’s records with relevant information.

The investigation revealed the following:
Regarding the allegation of staff did not administer prescribed medication to a resident in care, it was alleged that staff failed to give resident#1 (R1) with one of resident’s prescribed medication.
(- continued in LIC 9099 C-)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20231215112346

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: HEIGHTS SENIOR CARE, THE	FACILITY NUMBER: 197608079
	VISIT DATE: 12/19/2023

NARRATIVE

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Two (2) out of five (5) residents interviewed could not corroborate the allegation. Three (3) out of five (5) residents was attempted but failed to conduct interview. LPA interviewed R1’s representative (RR). RR could not corroborate the allegation. All two (2) staff interviewed denied the allegation. Per record reviews, it revealed residents’ prescribed medication was administered as prescribed. Per incident report and facility notes dated 12/13/23, R1 did not come with the claimed prescribed medication upon arrival at the facility after discharged from the hospital. R1 was sent back to the same hospital in about 2 hours after discharged on the same day. Therefore, staff could not administer R1's medication since R1 did not come to the facility with the claimed prescribed medication. Due to the short period of staying (~2 hours), administrator did not have sufficient time to obtain R1’s medication from R1’s pharmacy. Thus, there was not preponderance of evidence to show staff did not administer prescribed medication to the resident.

Regarding the allegation of facility illegally evicted a resident in care, it was alleged that facility refused to accept the resident#1 (R1) back into the facility after discharged from hospital. Two (2) out of five (5) residents interviewed could not corroborate the allegation. Three (3) out of five (5) residents was attempted but failed to conduct interview. All two (2) staff interviewed denied the allegation. LPA interviewed R1’s representative (RR). RR stated RR chose to relocate R1 to a better placement for R1’s level of care. As a result, R1 was not returning to the facility. Therefore, facility did not illegally evicted resident in care.

Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegation is UNSUBSTANTIATED. No deficiencies are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 8.

An exit interview was conducted with Administrator. A hard copy of this report was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

LIC9099 (FAS) - (06/04)

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