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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004192
Report Date: 10/06/2021
Date Signed: 10/06/2021 01:00:52 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
03/16/2021 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20210316113905
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: 97DATE:
10/06/2021
UNANNOUNCEDTIME BEGAN:
11:58 AM
MET WITH:Carol LeeTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Resident has caused harm to other residents while in care
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegations via tele-visit due to COVID-19 and for precautionary measures. LPA met with Administrator (AD) Carol Lee and explained the reason for today’s inspection.

The investigation into the allegation that a resident has caused harm to other residents while in care revealed the following:

During the course of the investigation, LPA conducted an on-site inspection on 03/24/21, inspected the facility, interviewed residents and staff, and obtained and reviewed copies of facility records. Interviews with AD, residents, staff, and review of documents revealed that Resident #1 (R1) physically attacked four (4) residents prior to 03/24/21. The first resident sustained a cut, was bleeding, went to the hospital, then came back the same day.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
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-20210316113905
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: 10/06/2021
NARRATIVE
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The second resident suffered a small cut, refused the hospital, and received first aid at the facility. The third resident suffered a headache but refused the hospital. The fourth resident was not injured. AD also reported that on 05/04/21 R1 punched a staff member in the jaw resulting in jaw pain and that on 08/30/21 R1 was in an altercation with a resident which resulted in scratches to both residents. In response to these incidents, the facility attempted verbal redirection of R1 and obtaining a new medical assessment, which R1 refused. However, these measures have not been effective, and thus the facility has not protected residents from harm. In addition, interviews with AD and review of documents revealed that the facility did not reappraise R1’s care needs for two (2) years despite R1’s change of condition and increased aggression which began in late 2019, and in any event was not providing adequate care and supervision to R1 as evidenced by R1’s attacks on other residents and the injuries R1 also sustained in some altercations. Thus, the allegation that a resident has caused harm to other residents while in care is substantiated.

During the course of the investigation, CCLD obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Facility representative via tele-visit. This report will be emailed and an electronic email read receipt confirms receipt of the report. Facility representative agrees to send a signed copy by email.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20210316113905
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: 10/06/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/07/2021
Section Cited
CCR
87464(f)(1)
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87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision… This requirement was not met as evidenced by: Based on interviews and documents, the facility did not provide R1 the care and
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Licensee states that R1 is being relocated to a facility that can meet R1’s needs on 10/7/21. Licensee states they will submit proof and details of relocation to LPA by 10/8/21.
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supervision they required as evidenced by R1’s multiple attacks on residents/staff and the injuries R1 also sustained in some altercations, which poses an immediate safety and personal rights risk to persons in care.
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Licensee states that if R1 has not been relocated by 10/15/21, Licensee will immediately begin the process to evict and relocate R1 to a facility that can meet R1’s needs and submit a status update to LPA by 10/22/21.
Type A
10/07/2021
Section Cited
CCR
87463(a)
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87463 Reappraisals (a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. … This requirement was not met as evidenced by: Based on interviews
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Licensee previously provided updated reassessments for R1 to LPA.
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and documents, the facility did not reappraise R1’s care needs for two (2) years despite R1’s change of condition and increased aggression which began in late 2019, which poses an immediate safety and 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) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
LIC9099 (FAS) - (06/04)
Page: 3 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
03/16/2021 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20210316113905

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: 97DATE:
10/06/2021
UNANNOUNCEDTIME BEGAN:
11:58 AM
MET WITH:Carol LeeTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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9
Staff did not seek timely medical attention for a resident
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation via tele-visit due to COVID-19 and for precautionary measures. LPA met with Administrator (AD) Carol Lee and explained the reason for today’s inspection.

The investigation into the allegation that Staff did not seek timely medical attention for a resident revealed the following:

During the course of the investigation, LPA conducted an on-site inspection on 03/24/21, inspected the facility, interviewed residents and staff, and obtained and reviewed copies of facility records. Interviews with AD, residents, staff, and review of documents revealed that Resident #1 (R1) physically attacked four (4) residents prior to 03/24/21. The first resident sustained a cut, was bleeding, went to the hospital, then came back the same day.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20210316113905
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: 10/06/2021
NARRATIVE
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The second resident suffered a small cut, refused the hospital, and received first aid at the facility. The third resident suffered a headache but refused the hospital. The fourth resident was not injured. On 08/30/21, R1 was in an altercation with a resident which resulted in scratches to both residents and both received first aid. Based on interviews and documents, the facility provided timely medical attention in these instances, either by taking the resident to the hospital, offering to take the resident to the hospital, and/or providing first aid at the facility. Interviews with affected residents corroborated their satisfaction with the medical care they were offered or received. Thus, the allegation that Staff did not seek timely medical attention for a resident is deemed to be unfounded.

The Department has investigated the above allegation and found it to be unfounded, meaning the allegation was false, could not have happened, or is without reasonable basis. An exit interview was conducted with Facility representative via tele-visit. This report will be emailed and an electronic email read receipt confirms receipt of the report. Facility representative agrees to send a signed copy by email.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5