306004192-8-29-2024-22-AS-MSTC-D8NK6G-20240831073730

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004192
Report Date: 08/29/2024
Date Signed: 08/29/2024 10:18:27 AM

Unfounded

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
12/21/2020 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20201221092131

FACILITY NAME:	WHITTEN HEIGHTS ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	306004192
ADMINISTRATOR:	CHIN SHUN LEE LIAU		FACILITY TYPE:	740
ADDRESS:	200 WEST WHITTIER BLVD.		TELEPHONE:	(562) 691-1200
CITY:	LA HABRA	STATE: CA	ZIP CODE:	90631
CAPACITY:	196	CENSUS: 127	DATE:	08/29/2024
		UNANNOUNCED	TIME BEGAN:	07:30 AM
MET WITH:	Allen Nishikawa		TIME COMPLETED:	09:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident's incontinent needs are not being met.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

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 Administrator (AD) Allen Nishikawa and explained the reason for today’s inspection.

The investigation into the allegation that a resident's incontinent needs are not being met revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, Chief Operating Officer (COO) Faye Shen, residents, and staff, and obtained and reviewed copies of the resident roster, staff roster, Resident #1’s (R1) Resident Appraisal dated June 22, 2018, R1’s Physician’s Report dated September 9, 2019, R1’s Physician’s Report dated October 8, 2019, and R1’s Admission Agreement dated June 22, 2018.

CONTINUED

Unfounded

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: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

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-20201221092131

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: 08/29/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding the allegation that a resident's incontinent needs are not being met: it was alleged that facility staff were repeatedly notified that R1 was running low on incontinence supplies, did not order incontinence supplies for R1, and R1 had to purchase incontinence supplies from another resident. When interviewed, R1 stated that they had been receiving incontinence supplies for free from the facility for the last two years, but that recently facility staff claimed that they had spoken to R1’s doctor and R1’s doctor and medical records indicated that R1 does not need incontinence supplies and R1 was told by facility staff that if they wanted incontinence supplies, they would have to pay an extra charge. LPA interviewed AD who was unable to provide information regarding this allegation. LPA interviewed COO and one facility staff who stated that residents like R1 who were placed by Los Angeles County were provided incontinence supplies by the facility at no extra charge if their physician’s report indicated they needed incontinence supplies, that they are unaware of any issues with R1 and incontinence supplies, that R1 did not need incontinence supplies because they were able to use the restroom and were not incontinent, and that the facility did not regularly supply R1 with incontinence supplies. LPA reviewed R1’s Resident Appraisal dated June 22, 2018, which indicates R1 does not need help with toileting or incontinence. LPA reviewed R1’s Physician’s Report dated September 9, 2019, and Physician’s Report dated October 8, 2019, which indicate R1 is not able to care for their own toileting needs but does not have incontinence. LPA reviewed R1’s Admission Agreement dated June 22, 2018, which indicates that the facility is not responsible for providing or paying for incontinence supplies, that R1 is responsible for paying for incontinence supplies, and that R1 was not paying for incontinence supplies. LPA interviewed eight additional residents and did not obtain information corroborating this allegation. No information was obtained corroborating the allegation because the information obtained showed that R1 did not have incontinence needs.

The Department has investigated the above allegation and found it to be Unfounded, meaning the allegation was false, could not have happened, or is without reasonable basis. 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: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

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
12/21/2020 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20201221092131

FACILITY NAME:	WHITTEN HEIGHTS ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	306004192
ADMINISTRATOR:	CHIN SHUN LEE LIAU		FACILITY TYPE:	740
ADDRESS:	200 WEST WHITTIER BLVD.		TELEPHONE:	(562) 691-1200
CITY:	LA HABRA	STATE: CA	ZIP CODE:	90631
CAPACITY:	196	CENSUS: 127	DATE:	08/29/2024
		UNANNOUNCED	TIME BEGAN:	07:30 AM
MET WITH:	Allen Nishikawa		TIME COMPLETED:	09:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff did not treat resident with respect.
Facility staff did not ensure resident received speech therapy.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

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 Administrator (AD) Allen Nishikawa and explained the reason for today’s inspection.

The investigation into the allegations that facility staff did not treat resident with respect and facility staff did not ensure resident received speech therapy revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, Chief Operating Officer (COO) Faye Shen, residents, and staff, and obtained and reviewed copies of the resident roster, staff roster, Resident #1’s (R1) Resident File, and Medication Administration Records (MAR) for multiple residents.

CONTINUED

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: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

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-20201221092131

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: 08/29/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding the allegation that facility staff did not treat resident with respect: it was alleged that facility staff spoke disrespectfully to R1. When interviewed, R1 stated that they had previously received the wrong medications which caused a severe reaction, so they double-check the medications they receive from the medication technician and on one occasion a medication technician responded to the resident’s request to double-check the medications by stating that even if the resident received the wrong medication and passed away, the medication technician’s job would be safe. Regarding the alleged past medication error, R1 did not specify if it occurred at this facility or another location. LPA reviewed R1’s Resident File and interviewed the staff in charge of medications and did not obtain information corroborating a medication error. LPA reviewed the MAR for R1 and four other residents and observed no medication errors of the severity described by R1. LPA interviewed AD who was unable to provide information regarding this allegation. LPA interviewed COO and two facility staff who denied this allegation and one staff reported that R1 verbally abused and threatened them. LPA interviewed eight additional residents and did not obtain information corroborating this allegation. The information obtained is conflicting.

Regarding the allegation that facility staff did not ensure resident received speech therapy: it was alleged that R1 missed two appointments of speech therapy that is conducted using the facility’s phone because the phone was purportedly not working at the time of the appointment, but another resident was observed using the phone that same day. When interviewed, R1 stated that during this incident a facility staff told R1 that “this phone will work for who we want it to work for, but it won’t work for you.” LPA interviewed AD who was unable to provide information regarding this allegation. LPA interviewed COO and one facility staff who denied the allegation and stated that R1 had their own phone and that R1 was not denied from using the facility’s phone for medical appointments. LPA interviewed eight additional residents and did not obtain information corroborating this allegation. The information obtained is conflicting.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above 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: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 4