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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004192
Report Date: 10/09/2020
Date Signed: 10/09/2020 02:52:34 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: DATE:
10/09/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Faye ShenTIME COMPLETED:
03:00 PM
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Licensing Program Manager (LPM) Marina Stanic, Licensing Program Analysts (LPAs) Sean Haddad, and Lydia Martinez arrived unannounced to the facility on this day for the purpose of conducting a Case Management visit. LPM Stanic and LPAs were greeted upon arrival by COO Faye Shen. Also present during this visit were Carol Lee, Administrator, Erick Merino, MedTech and Licensee's daughter Hsinya Shen and Licensees Hsui Shen and Su Chin Lin Shen via telephone.

LPM Stanic and LPAs Haddad and Martinez conducted this meeting to deliver Non-Compliance Conference Summary report which conference was conducted earlier this morning. LPM Stanic reviewed Summary report with above identified individuals and it was agreed that Licensee would submit requested items by the deadlines of 10/12/2020 and 10/14/2020.


An exit interview was conducted and a copy of this report was provided to Ms. Shen.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 355-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2020
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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