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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004192
Report Date: 02/01/2021
Date Signed: 02/01/2021 04:24:18 PM

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: 99DATE:
02/01/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Administrator Carol LeeTIME COMPLETED:
04:30 PM
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On today's date, Acting Regional Manager (ARM) Marina Stanic, Acting Licensing Program Manager (ALPM) Valarie Cook, and Licensing Program Analyst (LPA) Sean Haddad conducted a case management -- office meeting via Microsoft Teams due to COVID precautionary measures with Licensees Hsiu Shen and Su Chin Lin Shen, Licensees' daughter Hsinya Shen, Administrator (AD) Carol Lee, and COO Faye Shen. The purpose of the meeting was to follow up on the facility's completion of the Technical Support Program (TSP) and the items discussed during the 10/9/20 Non-Compliance Conference (NCC).

AD identified that through TSP, AD learned: the regulations and requirements in increased detail, the scope and frequency of updates to resident files (e.g., physicians' reports) and employee files, how to complete and maintain up-to-date admissions agreements with all attachments, reporting requirements, and training requirements including creating a plan to ensure proper training of staff as agreed to during the 10/9/20 NCC. Licensee agreed to submit the training plan by 2/25/21 and the mitigation plan by 2/8/21.

TSP identified that AD is filling 3 roles at the facility: administrator, kitchen manager, and accounting. Licensee agreed to hire a new bookkeeper to take over AD's accounting duties. Licensee agreed to assign the kitchen duties to a current staff member, with AD supervising when necessary. Licensee further agreed to take additional steps as necessary to ensure AD can devote their full attention to the administrator role.

Based on the observations and representations made during today’s office meeting, no deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with AD. 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 LPA.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 355-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2021
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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