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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004192
Report Date: 10/08/2020
Date Signed: 10/08/2020 04:23:45 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:MELCHOR DE LEONFACILITY TYPE:
740
ADDRESS:200 WEST WHITTIER BLVD.TELEPHONE:
(562) 691-1200
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:196CENSUS: 98DATE:
10/08/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Faye ShenTIME COMPLETED:
04:45 PM
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Licensing Program Manager (LPM) Marina Stanic and Licensing Program Analyst (LPA) Lydia Martinez made an unannounced Case Management visit to the facility to serve an Immediate Exclusion Order. LPM Stanic and LPA Martinez met with Chief Operating Officer Faye Shen and explained the reason for the visit. Administrator Melchor De Leon was present during this visit.

The Immediate Exclusion Order was explained to CEO Shen and Mr. De Leon. They both stated they understood the Order and said they had no questions. CEO Shen shared her temporary plan to replace the Administrator until one is hired.

LPM Stanic and LPA Martinez observed Mr. De Leon leaving facility with his possessions.

Exit interview was conducted, A copy of this report was left at the facility.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Lydia MartinezTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2020
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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