306005207-10-17-2025-22-AS-APAO-DMWN34-20251029100543

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005207
Report Date: 10/17/2025
Date Signed: 10/17/2025 03:37:35 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
10/17/2023 and conducted by Evaluator Alvaro Ramirez Jr.

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20231017103829

FACILITY NAME:	HARVEST RETIREMENT		FACILITY NUMBER:	306005207
ADMINISTRATOR:	GINGER PO		FACILITY TYPE:	740
ADDRESS:	9011 KNOTT AVE		TELEPHONE:	(714) 821-4130
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90620
CAPACITY:	106	CENSUS: 73	DATE:	10/17/2025
		UNANNOUNCED	TIME BEGAN:	12:52 PM
MET WITH:	Rose Enriquez-Administrator		TIME COMPLETED:	03:54 PM

ALLEGATION(S):

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Facility did not notify responsible party of incident
Facility staff tied residents to wheelchairs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegations received on October 17, 2023. LPA was greeted and granted entry into the facility and met with Administrator (AD) Rose Enriquez. LPA explained the reason for the visit.

This Department has investigated the complaint alleging that facility did not notify responsible party of incident. Regarding the allegation the following was revealed: During the course of the investigation LPA reviewed documents including the Unusual Incident/Injury Report (UIIR) dated October 15, 2023, for Resident 1 (R1). Per UIIR, on October 15, 2023, R1's wife and daughter were informed about R1 excessively sweating while walking in the hallway. Per UIIR, R1 was transported to the Hospital. During the course of the interviews with staff, Staff 1 (S1) reported that unusual incidents get reported to the Medication Technician who is in charge of notifying the Responsible Party (RP). During the course of the interviews with residents, R2 reported that if she has an incident that the facility notifies her RP.
CONTINUED ON LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025

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-20231017103829

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: HARVEST RETIREMENT	FACILITY NUMBER: 306005207
	VISIT DATE: 10/17/2025

NARRATIVE

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Per R3, the facility will report any incidents to her daughter on-time. R5 reported that the facility notifies his RP of incidents on-time. During the course of the interviews the Director of Operations reported that families get notified of unusual incidents the same day.

Regarding the allegation that facility staff tied residents to wheelchairs, the following was revealed: During the course of the interviews with individuals seven of eight individuals interviewed denied the allegation. During the course of the investigation LPA reviewed documents including the Moulton Family Medical Group lab buddy prescription dated September 6, 2023, for R1. Per AD, the lab buddy was prescribed to prevent falls for R1. During the course of the interviews with residents, R2 reported that she has not witness residents being tied to their wheelchair. R3 stated that he has never seen residents being tied to their wheelchair. Per R4, he has not witness residents being tied to their wheelchair. R5 reported that he has never witness residents being tied to their wheelchair. During the course of the interviews with staff, S1 reported that residents do not get tied to their wheelchair. Per S2, she has never witness residents being tied to their wheelchair during her shifts. During the course of the interviews the Director of Operations reported that she has never witness residents being tied to their wheelchair.

Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegations occurred as reported due to conflicting information. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed UNSUBSTANTIATED.

For today’s visit, there were no citations issued per Title 22, Division 6 of the California Code of Regulations.

LPA conducted an exit interview with AD Enriquez, and a copy of this report was provided to the facility.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025

LIC9099 (FAS) - (06/04)

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