306004192-9-22-2020-22-AS-AORZ-BTY3AB-20200930180428

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004192
Report Date: 09/22/2020
Date Signed: 09/22/2020 02:03:31 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/10/2020 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20200610152016

FACILITY NAME:	WHITTEN HEIGHTS ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	306004192
ADMINISTRATOR:	MELCHOR DE LEON		FACILITY TYPE:	740
ADDRESS:	200 WEST WHITTIER BLVD.		TELEPHONE:	(562) 691-1200
CITY:	LA HABRA	STATE: CA	ZIP CODE:	90631
CAPACITY:	196	CENSUS: 95	DATE:	09/22/2020
		UNANNOUNCED	TIME BEGAN:	01:07 PM
MET WITH:	Melchor De Leon		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility failed to seek medical attention for residents in a timely manner
Questionable death
Facility staff failed to meet the residents' needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman contacted the facility via telephone to deliver findings on a complaint investigation via telephone due to COVID-19 and pre-cautionary measures. LPA identified herself and discussed the purpose of the call and the elements of the allegations with Administrator Melchor De Leon. During the course of the investigation, the department interviewed staff and witnesses as well as reviewed and obtained pertinent documentation such as physician report dated 12/24/2019, CareMore medical records dated 05/06/2020-06/10/2020, and Placentia-Linda Hospital medical records dated 06/05/20-06/08/20.

The investigation revealed the following: Facility records obtained and reviewed list Resident 1 (R1)’s condition as being fair with a diagnosis of Parkinson’s Disease with a history of stroke per Physician report dated 12/24/2019. On 06/03/2020, R1’s responsible party received a call from a facility staff member indicating R1 was weak, had loose stools, and did not want to eat. The staff indicated R1 was being monitored for dehydration and a possible urinary tract infection. R1 was approved to go to a skilled nursing facility by their Care More Nurse for IV hydration, CONTINUED ON LIC 9099C DATED 09/22/2020.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2020

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

LIC9099 (FAS) - (06/04)

Page: 1 of 5

Control Number 22-AS-20200610152016

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: WHITTEN HEIGHTS ASSISTED LIVING AND MEMORY CARE	FACILITY NUMBER: 306004192
	VISIT DATE: 09/22/2020

NARRATIVE

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however R1’s responsible party was hesitant to send R1 to a skilled nursing facility due to Covid concerns. On 06/05/2020, the Care More Nurse called R1’s responsible party to discuss the “Do not Resuscitate (DNR)” order as R1 was declining. The nurse suggested placing R1 on hospice care or transferring R1 to the hospital. During the phone call, the nurse suggested that R1 had been exposed to Coronavirus. Responsible party decided to cancel R1’s DNR. R1’s Responsible party conducted a virtual visit with R1 the same day and observed R1 was weak and slurring their speech. Responsible party insisted R1 be transferred to the hospital instead of a skilled nursing facility. The facility communication log indicated R1 was sent out due to general weakness and no food intake for two days. No written notations were observed indicating R1 was exhibiting a fever while at the facility. R1 was transported to Placentia-Linda Hospital that day. Upon arrival, R1 was noted to have bilateral pneumonia, low grade fever, non-bloody diarrhea, and generalized weakness. The admitting diagnosis was weakness with associated diagnosis of hypoxia and pneumonia. While at the hospital, R1 was tested for Covid-19 and received a positive diagnosis. Per hospital medical records, R1 was noted to be alert, no acute distress, and not ill-appearing. Hospital records indicate no evidence of abuse/ neglect was suspected. R1 passed away while at the hospital on 06/08/2020. The discharge report from Care More Health dated 06/10/20 indicated a discharge diagnosis of “Acute Respiratory Failure with Hypoxia.” The Death report for R1 indicates Acute Hypoxic Respiratory Distress as the main cause of death with Septic Shock, Pneumonia, and Covid-19 as underlying causes.
Additional incidents alleging failure to seek timely medical attention were further received in which it was reported that Resident 2 (R2) was found on the floor in the facility memory care, Resident 3 (R3) was not sent out to the hospital when presenting with a fever and Resident 4 (R4) was observed vomiting an unknown white foam from the mouth. Three out of three staff interviewed state that 911 was called immediately regarding R2’s fall and was transferred to the hospital where the resident received medical attention. Staff indicate that they are unaware of any other incidents with R2. Three out of three staff interviewed indicate R3 was moved out to a skilled nursing facility on May 7, 2020 before the Covid outbreak in the facility and did not have any illness. R3 was referred to a skilled nursing facility by their Care More nurse due to becoming bed bound and needing a higher level of care. All decisions regarding hospitalization was discussed with the nurse prior to R3’s transfer. Regarding R4 being observed foaming at the mouth, R4 was determined to be receiving hospice care due to declining health conditions and subsequently passed away on 06/09/2020. Staff interviewed denied observing R4 foaming at the mouth. CONTINUED ON LIC 9099C DATED 09/2020.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/10/2020 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20200610152016

FACILITY NAME:	WHITTEN HEIGHTS ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	306004192
ADMINISTRATOR:	MELCHOR DE LEON		FACILITY TYPE:	740
ADDRESS:	200 WEST WHITTIER BLVD.		TELEPHONE:	(562) 691-1200
CITY:	LA HABRA	STATE: CA	ZIP CODE:	90631
CAPACITY:	196	CENSUS:	DATE:	09/22/2020
		UNANNOUNCED	TIME BEGAN:	01:07 PM
MET WITH:			TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility staff failed to provide a safe, healthy and comfortable environment for the residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman contacted the facility via telephone to deliver findings on a complaint investigation via telephone due to COVID-19 and pre-cautionary measures. LPA identified herself and discussed the purpose of the call and the elements of the allegations with Melchor De Leon. During the course of the investigation, the department interviewed staff and witnesses as well as reviewed and obtained pertinent documentation.
The investigation revealed the following: During the course of the investigation, LPA toured the facility and observed the interior of the facility including but not limited to Resident 5’s (R5) room via FaceTime. LPA observed a mattress that fit the bed properly in R5’s former room and the room was observed to be clean and comfortable. Facility representative stated that nothing had been removed from the room. LPA observed the facility to be clean and orderly during the tour. Based on records reviewed, the facility conducted Covid testing on 6/1/20 by the Local Health Department (LHD) after a staff member who had been on previously scheduled medical leave reported testing positive. The staff member had not been present at the facility for approximately two weeks prior to being tested positive. CONTINUED ON LIC 9099C DATED 09/09/2020.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2020

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

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 22-AS-20200610152016

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: WHITTEN HEIGHTS ASSISTED LIVING AND MEMORY CARE	FACILITY NUMBER: 306004192
	VISIT DATE: 09/22/2020

NARRATIVE

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Following testing conducted on 6/1/20, the first confirmed positive results were received by the facility on 6/3/20. On 6/5/20 the facility reported the outbreak to the Department. On 6/12/20 the facility received a letter from the LHD providing recommendations to follow in an effort to manage the outbreak. An interview conducted with a LHD official confirmed that the facility was compliant with recommendations provided. A virtual visit was completed by Department staff and a Health Field Evaluator Nurse (HFEN) for compliance with Department issued guidelines for infection control. No concerns were noted following the visit. The facility remained in daily communication with the Department during the reported outbreak. The facility has since been cleared by the LHD to begin readmitting new residents. During LPA’s visit, a separate unit for Covid positive residents with appropriate signage and precautions were observed. No known cases of Covid remain active at the facility to date. The facility continues to conduct random testing in compliance with Department guidelines.

Therefore, allegations are deemed UNFOUNDED, meaning the allegations are false could not have happened and/or is without a reasonable basis. An exit interview was conducted with Administrator via telephone and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) was provided to Administrator via email and an electronic email read receipt confirms receiving these documents.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2020

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 22-AS-20200610152016

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: WHITTEN HEIGHTS ASSISTED LIVING AND MEMORY CARE	FACILITY NUMBER: 306004192
	VISIT DATE: 09/22/2020

NARRATIVE

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Therefore, based on documents reviewed and interviews conducted, the allegations are deemed UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted with Administrator via telephone and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) was provided to Administrator via email and an electronic email read receipt confirms receiving these documents.

*This is an amended report due to inadvertently leaving out Administrator's name.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2020

LIC9099 (FAS) - (06/04)

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