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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602987
Report Date: 02/25/2025
Date Signed: 02/25/2025 02:54:13 PM

Document Has Been Signed on 02/25/2025 02:54 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:HEIGHTS INN, THEFACILITY NUMBER:
198602987
ADMINISTRATOR/
DIRECTOR:		QUEZADA, JESSEFACILITY TYPE:
740
ADDRESS:2400 PANCHOY PLTELEPHONE:
(562) 488-3830
CITY:LA HABRA HEIGHTSSTATE: CAZIP CODE:
90631
CAPACITY: 9TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
02/25/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:10 PM
MET WITH:Staff Cynthia Tadeo TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to staff Cynthia Tadeo. The following domains were completed:

Infection Control:

  • Infection control practices and Personal Protective Equipment (PPEs) were observed. COVID-19 screening is no longer in place. An Infection Control Plan was observed
Physical Plant/Environment Safety:
  • The facility is located in a residential neighborhood. The facility includes a staff office, laundry room, dining area, common area/TV room, staff bathroom, (6) residents bedrooms and (6) resident bathrooms and a detached garage. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. There are no bodies of water in the facility.
  • Water temperature readings measured within title 22 regulations.
Operational Requirements:
  • A current Plan of Operation was observed.
  • Fire clearance approved for (9) residents with age range 60 and over. Clearance is approved for up to (9) Non-ambulatory and has an approved hospice waiver for up to five (5) residents.
  • Facility has an active liability insurance. Copy was collected and reviewed
Personnel Records - Staff Training:
  • Administrator on file is current. Administrator certificate is currently active
  • Four (4) staff files were reviewed. Required documents observed for files reviewed.
Staffing:
  • Sufficient staff observed during visit
  • Night Shift staff sufficient.

Continued on LIC 809-C
Fernando FierrosTELEPHONE: (323) 981- 3981
Jose VillalobosTELEPHONE: (323) 980-4939
DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2025
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: 02/25/2025
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Resident Records - Incident Reports:
  • A total of Five (5) resident files were reviewed. Required documents observed
Resident Rights - Information
  • Required postings observed
  • Facility provides internet services to residents in care
Food Service:
  • Sanitation practices and kitchen cleanliness was observed.
  • Kitchen has utensils for clients to use and to store their meals
Planned Activities:
  • Sufficient space to accommodate both indoor and outdoor activities was observed.
  • Activities supply observed
Incident Medical and Dental:
  • Emergency transportation available
  • First Aid Kid observed
  • Five (5) Resident medications were reviewed.
Disaster Preparedness:
  • Emergency and Disaster Plan observed
  • Emergency drill last conducted 1/10/2025
Residents with Special Health Needs:
  • Needs and Services Plans are on file for all residents.
  • There are no residents receiving home health services
  • Currently One (1) Resident is on hospice. Hospice service agreement observed

Inspection Tool was completed and per Title 22 there are no deficiencies being cited on todays visit. Exit interview conducted. Copy of this report was provided.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
LIC809 (FAS) - (06/04)
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