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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602987
Report Date: 03/09/2022
Date Signed: 03/10/2022 09:45:35 AM


Document Has Been Signed on 03/10/2022 09:45 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 INN, THEFACILITY NUMBER:
198602987
ADMINISTRATOR:QUEZADA, JESSEFACILITY TYPE:
740
ADDRESS:2400 PANCHOY PLTELEPHONE:
(562) 536-8860
CITY:LA HABRA HEIGHTSSTATE: CAZIP CODE:
90631
CAPACITY:6CENSUS: 6DATE:
03/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Jesse Quezada-Administrator TIME COMPLETED:
05:00 PM
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Licensing Program Analysts (LPAs) Christine Wong, Bennette Pena and Ashley Calderon conducted an annual required visit. LPA met with staff Jacqueline Portillo and explained the reason for the visit. Shortly after, the administrator Jesse Quezada arrived and assisted with the visit. LPA used the infection control tool to evaluate the facility. LPA observed the facility plant, COVID-19 procedures, reviewed residents' medications, observed food supply, and reviewed resident and staff files. Facility has submitted a mitigation plan and was approved on 05/15/21

The facility is located up on the hill and in a residential neighborhood. The facility consists of staff office, laundry room, kitchen, dinning room, two living rooms, and six residents bedrooms, six residents bathrooms, one staff bathroom and a detached garage. All resident bedrooms were toured. Each bedroom has a smoke detector, chair, bed, night stand, required linen, dresser, sufficient closet space and light. All residents bathrooms were toured. Bathrooms have the required grabs bars and non-skid mats. The hot water tested between 105 and 110 degrees F which is within the Title 22 regulation. For the food supply, they have required two days perishable and seven days non perishable food. All the appliances are clean and working properly. The back and front yard are maintained well and The front yard has a shaded area and sitting area and its free of obstruction. LPA also checked the carbon monoxide detector and they are all inter-connected and working well.

LPA reviewed six (6) residents files to confirm emergency contact is updated. LPA also reviewed three (3) staff files to confirm health screenings and fingerprint clearances. LPA also reviewed all six (6) residents' medications and they are all centrally stored , records are updated and accurate.

Facility is currently following COVID 19 recommendations regarding COVID 19 signs throughout the facility, social distancing and disinfecting the facility in every shift. The restrooms have sufficient soap, paper towels, and signs. The PPE supplies are stored for 30 days.
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine WongTELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 INN, THE
FACILITY NUMBER: 198602987
VISIT DATE: 03/09/2022
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There's no deficiencies observed during the visit.

Exit Interview Conducted. A copy of the report was provided to administrator Jesse Quezada.
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine WongTELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022
LIC809 (FAS) - (06/04)
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