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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004192
Report Date: 11/13/2020
Date Signed: 11/17/2020 04:29:15 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
07/14/2020 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20200714134015
FACILITY NAME:WHITTEN HEIGHTS ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
306004192
ADMINISTRATOR:MELCHOR DE LEONFACILITY TYPE:
740
ADDRESS:200 WEST WHITTIER BLVD.TELEPHONE:
(562) 691-1200
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:196CENSUS: 97DATE:
11/13/2020
UNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Administrator Carol LeeTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Facility is restraining resident to prevent falls
Facility locked resident in room
Facility failed to report incidents to licensing
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Sean Haddad and Shobhana Frank contacted the facility via tele-visit due to COVID-19 precautionary measures to deliver findings for the investigation into the above identified complaint allegations. LPAs spoke with Administrator Carol Lee and explained the purpose of the telephone call.

The investigation into allegations that the Facility is restraining resident to prevent falls, that the Facility locked resident in room, and that the Facility failed to report incidents to licensing revealed the following:

During the course of the investigation, LPAs obtained photographs, conducted interviews of staff and residents during on-site inspections (on 10/1 and 10/5/20), and observed residents being restrained and tied to their wheelchairs and locked in their rooms. On 10/1/20, LPAs conducted an on-site inspection and interviewed 18 residents and nine (9) staff.
(Continued on 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 355-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2020
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 4
Control Number 22-AS-20200714134015
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: 11/13/2020
NARRATIVE
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LPAs observed Resident #1 (R1) tied to a wheelchair. On 10/5/20, LPAs conducted an on-site inspection and interviewed 12 residents, 11 staff and observed Resident #2 (R2) locked in their room and Resident #3 (R3) and Resident #4 (R4) locked in an isolated wing of Facility. LPAs interviewed Staff #1 (S1) who stated they witnessed residents being tied up and that this is a common occurrence, this statement was corroborated by Resident #5 (R5) and Resident #6 (R6) who stated they observed other residents being tied up. In addition, Seven (7) staff interviewed admitted that the Facility had a pattern and practice of tying up residents. LPAs interviewed Staff #2 (S2) who indicated staff regularly lock resident rooms when the residents are outside of their rooms. Staff #3 (S3) disclosed that Administrator Melchor De Leon instructed staff to stop reporting resident falls and similar incidents directly to CCLD but to instead report internally to the administrator. As a result of this internal reporting procedure, multiple falls and similar incidents were reported internally but not reported to CCLD. Administrator Melchor De Leon confirmed that Facility was not reporting incidents as they were occurring.

Based on interviews, documents, and observations, the preponderance of evidence standard has been met; therefore, the above allegations are substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations.

The violation of residents’ personal rights resulting from Facility locking residents in their rooms was previously cited during a Case Management Visit on 10/7/20.

An exit interview was conducted with Administrator via tele-visit a copy of the report along with appeal rights was sent via email and an electronic email read receipt confirms receiving of the report. Administrator agrees to review, agrees to send the signed report via email.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 355-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 22-AS-20200714134015
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/13/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/14/2020
Section Cited
CCR
87468.1(a)(2)
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Personal Rights of Residents …: (a) Residents … shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by:
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Licensee states they will immediately remove from Facility all straps which were used or could be used to restrain residents to wheelchairs and will instruct and train staff to never tie or otherwise restrain residents to wheelchairs.
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Based on LPAs’ observations, interviews, and photographs, Facility restrained and tied residents to their wheelchairs for extended periods of time. This poses an immediate health, safety, and/or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 355-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 22-AS-20200714134015
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/13/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/27/2020
Section Cited
CCR
87211(a)(1)(D)
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87211 Reporting Requirements: (a) Each licensee shall furnish ... (1) A written report ... within seven days of the occurrence of ... (D) Any incident which threatens the welfare, safety or health ... of any resident. This requirement was not met as evidenced by:
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Licensee states they will re-read Section 87211 Reporting Requirements and submit a statement of understanding to CCLD by POC due date and instruct and train staff to follow the Section 87211 Reporting Requirements.
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Based on LPAs’ interviews, Facility engaged in a pattern and practice of not reporting resident falls and similar incidents to CCLD. This poses a potential health, safety, and/or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 355-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2020
LIC9099 (FAS) - (06/04)
Page: 4 of 4