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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004192
Report Date: 11/14/2022
Date Signed: 11/14/2022 04:42:22 PM


Document Has Been Signed on 11/14/2022 04:42 PM - It Cannot Be Edited

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: 92DATE:
11/14/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Carol Lee, Faye ShenTIME COMPLETED:
03:00 PM
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On today’s date, Regional Manager (RM) Marina Stanic, Licensing Program Manager (LPM) Armando Lucero, and Licensing Program Analyst (LPA) Sean Haddad conducted a virtual meeting via Microsoft Teams with Administrator (AD) Carol Lee and Chief Operating Officer (COO) Faye Shen. Also present were Long-Term Care Ombudsman (LTCO) Nancy Bejarano, LTCO Program Orange County Director Elizabeth Anderson, and Care Coordinator Damond Stewart, Program Manager Steven Rivera, and Program Manager Esther Aguilera of Housing for Health Department of Health Services (DHS).

During the meeting, the following items were discussed:
  • The pending eviction of Resident #1 (R1) who has recently engaged in aggression, threatening behavior, and property damage at the facility.
  • Future placement options for R1.
  • The facility’s measures to ensure the health and safety of R1 and other residents pending future placement.
  • That R1 was recently hospitalized on a 5150 hold and is currently hospitalized on a 5250 hold.
  • That R1 has not been compliant with medications.

During the meeting, the following was agreed upon:
  • DHS has requested a mental health caseworker to help provide mental health services to R1.
  • DHS is working to find new placement that can meet R1’s needs before the 5250 hold expires.
  • The facility will request a discharge meeting with the hospital where R1 is hospitalized and notify LPA and DHS.
  • That a follow-up meeting will be held to discuss next steps prior to R1’s 5250 hold expiring.

An exit interview was conducted. This report will be emailed and an electronic email read receipt confirms receipt of the report. Facility representative agrees to sign the report and email it back to LPA.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2022
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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