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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004192
Report Date: 10/07/2020
Date Signed: 10/07/2020 07:45:10 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: 98DATE:
10/07/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
05:50 PM
MET WITH:Melchor De LeonTIME COMPLETED:
08:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Joseph Alejandre and Sean Haddad made an unannounced case management visit to deliver citations to the facility Administrator (AD). LPAs were greeted and granted entry by Christian Martinez. LPAs explained the reason for the visit. LPAs met with facility AD Melchor De Leon. During the investigation of the complaint # 22-AS-20200917140130, LPAs observed the following violations of Title 22 regulations on October 5, 2020. LPA Alejandre observed R1 was locked in their room on the second-floor memory care unit. LPA Alejandre had caregivers unlock the room so R1 could enter and exit their room freely. LPA Alejandre and LPA Haddad observed Resident 2 (R2) had an oxygen machine and oxygen tank in their room. Staff verified that R2 uses the oxygen regularly. LPAs observed no oxygen-in-use sign on R2’s door or in the nearby hallway. Staff verified that R2 uses the oxygen regularly. LPA Alejandre and Haddad observed Resident 3's (R3) and Resident 4’s (R4) rooms were only accessible through two hallway doors that were kept locked. R3 and R4 could not freely walk through memory care unit on the third floor. LPAs Alejandre and Haddad observed that R3 had no pants on when they entered the room. R3 stated that they had no pants and haven’t had their pants since they moved in 3 days ago. LPAs Alejandre and Haddad observed that R3 did not have any pants in their box of clothes or dresser. LPM Stanic had a staff member provide pants for R3. LPAs observed the signal system in R3's room was not operational. LPA pulled the signal system cord at 8:19 am and no one answered the call. LPA Alejandre observed the call log at the front desk and it did not list the call. LPAs observed that the pull cord for the call system in the room of Resident 5 (R5) had been tied up so as to be out of reach of R5, leaving R5 with no way to activate the signal system in case of an emergency. Based on observations the following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with the AD Melchor De Leon and a copy of this report was provided along with appeal rights. LPAs also conducted a health and safety inspection during todays visit. LPAs observed facility was kept at a comfortable temperature and observed walkways and hallways free of debris and/or clutter. LPAs observed facility to be well lit. LPAs observed residents watching TV and sitting in the common areas. LPAs observed fire extinguishers mounted and charged throughout facility. No health and safety concerns were noted during todays visit. Copy of report signed by and provided to AD Melchor De Leon.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/08/2020
Section Cited

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Personal Rights of Residents in all Facilities. To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This does not prohibit a licensee from establishing house rules, such as locking doors at night to protect residents, or barring windows against intruders, with permission from the Department.
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This requirement is not being met as evidenced by; LPA observed R1 locked in their room in the memory care unit. LPA observed R3’s room is not accessible except through locked hallway doors. This poses an immediate health and safety risk to residents in care.
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 Licensee to forward proof to LPA by POC due date.
Type A
10/08/2020
Section Cited

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87303 (a) Maintenance and Operation
The facility shall be clean, safe, sanitary and in good repair at all times...This requirement was not met as evidenced by: Based on observation the Licensee did not provide a pull cord on the call system to R 4’s room.
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R4 did not have a way to call for assistance in case of an emergency which poses an immediate safety risk to residents in care.
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Licensee will provide proof of correction to LPA by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE: 10/07/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/08/2020
Section Cited

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Maintenance and Operation. (i) Facilities shall have signal systems which shall meet the following criteria:(1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall:(A) Operate from each resident's living unit. This requirement is not being met as evidenced by,
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LPA attempted to operate the signal system and it was not operable as observed by the LPA, LPA pulled the signal cord in Resident 3’s room on Monday at 8:19 am and no one responded by 8:29 am. LPA reviewed front desk call log and the call LPA initiated was not logged on the call log. This poses an immediate health and safety risk to residents in care
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 Licensee to forward proof to LPA by POC due date.
Type B
10/15/2020
Section Cited

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Oxygen Administration, "No Smoking-Oxygen in Use" signs shall be posted in the appropriate areas. This requirement is not being met as evidenced by:
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During the visit, LPA observed R2 has an Oxygen machine present in their room and there are no "Oxygen in Use" signs present on their door or anywhere nearby as this is a large facility. This poses a potential risk to the health and safety of the residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE: 10/07/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/15/2020
Section Cited

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Personal Rights of Residents in All Facilities - To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not being met as evidenced by,
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LPAs observed R3 did not have any pants, and had requested his pants from staff but had no pants on, or in their room. R3 was not given pants until LPM Stanic asked staff to provide R3 with pants.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE: 10/07/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4