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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004192
Report Date: 01/27/2022
Date Signed: 01/27/2022 01:13:06 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: 94DATE:
01/27/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Carol Lee, AdministratorTIME COMPLETED:
01:30 PM
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Licensing Program Analysts (LPAs) Ruth Martinez is conducting this case management for the purpose of a health and safety check. This visit is being conducted due to COVID-19 and for pre-cautionary measures. LPA arrived at facility was greeted by receptionist and check in via covid guidelines. LPA met with Carol Lee, Administrator and explained the nature of the visit.

During the case management visit LPA took a tour of the physical plant of the facility. LPA observed that meals are being served per floor for safety measures and tray service is provided as well. LPA observed facility Mitigation plan to be used adequately to aid with Covid safety measures. LPA observed hallways and walkways were free of obstruction. LPA observed residents keeping social distancing throughout the facility. LPA reviewed residents’ records and staff records. LPA obtained copies of pertinent records. Administrator agreed to submit via email requested records. There are no health and safety concerns observed in the facility.

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 facility representative and a copy of this report was left at facility.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Ruth MartinezTELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022
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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