306004192-5-8-2025-22-AS-LMOA-DGXNC8-20250523102017

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004192
Report Date: 05/08/2025
Date Signed: 05/08/2025 12:30:29 PM

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
05/07/2025 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20250507114305

FACILITY NAME:	WHITTEN HEIGHTS ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	306004192
ADMINISTRATOR:	STEVE SHEN		FACILITY TYPE:	740
ADDRESS:	200 WEST WHITTIER BLVD.		TELEPHONE:	(562) 691-1200
CITY:	LA HABRA	STATE: CA	ZIP CODE:	90631
CAPACITY:	196	CENSUS: 118	DATE:	05/08/2025
		UNANNOUNCED	TIME BEGAN:	07:30 AM
MET WITH:	Faye Shen		TIME COMPLETED:	09:00 AM

ALLEGATION(S):

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Due to lack of supervision, resident was physically assaulted by another resident causing a bruise

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 allegation. LPA met with Chief Operating Officer (COO) Faye Shen and explained the reason for today’s inspection.

The investigation into the allegation that due to lack of supervision, resident was physically assaulted by another resident causing a bruise revealed the following: During the course of the investigation, LPA inspected the facility, interviewed residents and staff, and obtained and reviewed copies of the resident roster, staff roster, Resident #2’s (R2) Physician’s Report dated January 1, 2025, and R2’s Appraisal/Needs and Services Plan dated February 1, 2024.

CONTINUED

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025

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

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20250507114305

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: 05/08/2025

NARRATIVE

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It was alleged that, due to staff’s lack of care and supervision of residents in the memory care unit, on May 3, 2025, Resident #1 (R1) was attacked by R2, who has a history of aggressive behavior, resulting in a bruise. LPA inspected the facility, conducted health and safety checks on residents, including R1 and R2, noted that R1 has a small bruise on their cheek and that R1 has been relocated to another floor in the memory care unit, and observed no health and safety issues. LPA interviewed R1 and R2 who denied engaging in any fights or sustaining any injuries, stated they receive good care at the facility, and denied having any problems at the facility. LPA interviewed the facility’s medication technician supervisor who stated that on May 3, 2025, staff in the third-floor memory care heard a fall, observed R1’s door open with R1 on the floor inside and R2 standing outside the room, noted no serious injuries on R1, offered R1 first aid and reported the fall to R1’s doctor, but did not observe whether R1 fell or was pushed by R2. Per the facility’s medication technician supervisor, three caregivers are assigned to the third-floor memory care and the facility’s resident roster indicates there are 35 residents in the third-floor memory care. Interviews with staff confirmed that three caregivers were working on the third-floor memory care at the time of the incident. LPA interviewed three staff who were witnesses to the incident, and one confirmed seeing R2 push R1 causing R1’s fall. All four staff interviewed also confirmed that R2 has a history of aggression. LPA reviewed R2’s Physician’s Report dated January 1, 2025, which indicates R2 has Dementia, and R2’s Appraisal/Needs and Services Plan dated February 1, 2024, which was not updated as required due to R2’s Dementia diagnosis, does not indicate R2 has a history of aggressive behavior as confirmed by facility staff, or provide a care plan to address R2’s aggressive behavior. Interviews with three staff confirmed that the incident was caused when R2 was left to wander around the memory care, confirming that no special care was provided to address R2’s aggressive behavior. The information obtained corroborated the allegation.

During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. Civil penalties for repeat violations are being assessed. See LIC421FC. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20250507114305

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/08/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/09/2025 Section Cited CCR 87464(f)(1)	1 2 3 4 5 6 7	87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision… This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The licensee stated they reassess R2 and create a care plan for their aggression and will review their roster, identify residents with aggressive behavior, and create care plans to address those aggressive behaviors, and submit proof to LPA by POC due date.
	8 9 10 11 12 13 14	Based on documents and interviews, the licensee did not ensure R2 received care and supervision for their aggressive behavior resulting in R1’s injury, which poses an immediate safety risk to persons in care. CIVIL PENALTY ASSESSED	8 9 10 11 12 13 14
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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.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025

LIC9099 (FAS) - (06/04)

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