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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004192
Report Date: 02/27/2024
Date Signed: 02/27/2024 03:51:12 PM


Document Has Been Signed on 02/27/2024 03:51 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:WHITTEN HEIGHTS ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
306004192
ADMINISTRATOR:STEVE SHENFACILITY TYPE:
740
ADDRESS:200 WEST WHITTIER BLVD.TELEPHONE:
(562) 691-1200
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:196CENSUS: 115DATE:
02/27/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:35 PM
MET WITH:Faye Shen- Chief Operating OfficerTIME COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA) Jessica Cho continued the visit after delivering the findings in connection to Complaint Control Number: 22-AS-20230707101643. LPA stated the purpose of the Case Management visit to Chief Operating Officer Faye Shen.

During the course of the complaint investigation mentioned above, LPA discovered that the Department received a written report on July 7, 2023, pertaining to an altercation exchanged between Resident #1 (R1) and Resident #2 (R2) that occurred on June 24, 2023. The incident report was received 13 days after the occurrence. Per Reporting Requirements 87211, a written report shall be submitted to the licensing agency seven days of the occurrence.

Therefore, as a result of today’s Case-Management visit, a Technical Advisory Note (LIC9102) will be issued.

An exit interview was conducted with Chief Operating Officer Faye Shen, and a copy of this report including the LIC9102 and the LIC811 were provided at the end of the visit.
SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2024
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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