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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004192
Report Date: 11/03/2020
Date Signed: 11/03/2020 11:05:13 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 CAREFACILITY NUMBER:
306004192
ADMINISTRATOR:CHIN SHUN LEE LIAUFACILITY TYPE:
740
ADDRESS:200 WEST WHITTIER BLVD.TELEPHONE:
(562) 691-1200
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:196CENSUS: 100DATE:
11/03/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Administrator Carol LeeTIME COMPLETED:
10:58 AM
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Licensing Program Analysts (LPAs) Sean Haddad and Shobhana Frank conducted an unannounced Case Management visit for the purpose of a health and safety check via FaceTime due to COVID-19 Pandemic and precautionary measures. LPAs explained the reason for today's visit and conducted a virtual tour of the inside of the facility, common areas, and kitchen along with Administrator (AD) Carol Lee and observed the following:

LPAs observed there was one receptionist in the main entrance of the facility. AD reported there were 2 caregivers on each of 3 floors, 3 med techs, 3 activity directors, and 5 kitchen staff, along with other staff. LPAs observed 2 caregivers (wearing masks) on 2nd and 3rd floors, 3 med techs (wearing masks), 1 activity director (wearing mask), and 5 kitchen staff (wearing masks), along with other staff. LPAs observed no locked doors on 2nd or 3rd floor memory care. LPAs observed that food storage areas were clean and organized. LPAs observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. LPAs noted hallways and walkways were free of obstruction.

There were no health and safety concerns observed in the areas inspected. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations.

An exit interview was conducted with AD via telephone. This report will be emailed and an electronic email read receipt confirms receipt of the report. AD agrees to sign the report and email it back to LPAs.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 355-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2020
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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