306004192-7-28-2023-22-AS-MSTC-CUD6KG-20230803205241

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004192
Report Date: 07/28/2023
Date Signed: 07/28/2023 09:26:37 AM

Substantiated

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
09/17/2020 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200917140130

FACILITY NAME:	WHITTEN HEIGHTS ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	306004192
ADMINISTRATOR:	MELCHOR DE LEON		FACILITY TYPE:	740
ADDRESS:	200 WEST WHITTIER BLVD.		TELEPHONE:	(562) 691-1200
CITY:	LA HABRA	STATE: CA	ZIP CODE:	90631
CAPACITY:	196	CENSUS: 100	DATE:	07/28/2023
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Allen Nishikawa		TIME COMPLETED:	09:40 AM

ALLEGATION(S):

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Staff locked residents in their rooms
Staff tied up residents.

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. LPA met with General Manager (GM) Allen Nishikawa, discussed the purpose of the inspection, and explained the allegation.

The allegations that staff locked residents in their rooms and staff tied up residents were investigated by the Department and consisted of inspections, interviews conducted with the facility staff, Administrator, witnesses, and residents, as well as documentation review, and revealed the following:

Staff admitted to restraining residents while they were in their wheelchairs with a Posey Gait belt. One of the Posey Gait belts was confiscated and placed into IB evidence.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023

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 4

Control Number 22-AS-20200917140130

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: 07/28/2023

NARRATIVE

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The explanation the caregivers gave was that it was for the residents’ personal safety so they would not fall and get hurt and that other staff members did it, so they did it as well. Staff stated that neither the [former] Administrator nor the Assistant ever told them they could not restrain residents or lock residents in their rooms. Staff admitted to locking the residents in their rooms starting at 7:00 p.m. to keep them safe and so they would not wander and go into other residents’ rooms and take things that do not belong to them. The testimony provided by caregivers is corroborated by color photographs which depicted residents restrained in their wheelchairs.

During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegations mentioned above. The preponderance of evidence standard has been met; therefore, the above allegations are Substantiated. The violation of residents’ personal rights resulting from the facility locking residents in their rooms was previously cited as a deficiency during a Case Management Visit on 10/7/20. The violation of residents’ personal rights resulting from the facility restraining residents inappropriately was already cited as a deficiency in connection with Complaint Control No. 22-AS-20200714134015 on 11/13/20. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
09/17/2020 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200917140130

FACILITY NAME:	WHITTEN HEIGHTS ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	306004192
ADMINISTRATOR:	MELCHOR DE LEON		FACILITY TYPE:	740
ADDRESS:	200 WEST WHITTIER BLVD.		TELEPHONE:	(562) 691-1200
CITY:	LA HABRA	STATE: CA	ZIP CODE:	90631
CAPACITY:	196	CENSUS: 100	DATE:	07/28/2023
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Allen Nishikawa		TIME COMPLETED:	09:40 AM

ALLEGATION(S):

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Resident sustained injury while in care
Staff are overdosing residents
Staff did not seek medical attention for resident
Staff did not notify residents authorized representative of incident
Residents needs not being met

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. LPA met with General Manager (GM) Allen Nishikawa, discussed the purpose of the inspection, and explained the allegation.

The allegations that resident sustained injury while in care, staff are overdosing residents, staff did not seek medical attention for resident, staff did not notify residents authorized representative of incident, and residents needs not being met were investigated by the Department and consisted of inspections, interviews conducted with the facility staff, Administrator, witnesses, and residents, as well as documentation review, and revealed the following:

Resident #1 (R1) and Resident #2 (R2) did have injuries while at the facility but received medical attention and their authorized representatives were notified immediately.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 22-AS-20200917140130

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: 07/28/2023

NARRATIVE

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R1’s family member, Witness #1 (W1), felt R1’s needs were being meet and had much respect for the facility itself. Witness #2 (W2), family member of R2, felt R2’s needs were being met, but did feel R2 was over medicated due to R2 being more wheelchair bound and in bed more on W2’s visits. However, facility Med-Techs were interviewed and denied overdosing residents as they followed the Medication Administration Records (MAR) and documented every medication given to the residents per the log. Family members for Resident #3 (R3) were not contacted as R3 has a public guardian and Resident #4 (R4) and Resident #5 (R5) are under the guide of Department of Health Services. The investigation did not reveal any additional evidence to corroborate these allegations.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023

LIC9099 (FAS) - (06/04)

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