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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005207
Report Date: 10/26/2023
Date Signed: 10/26/2023 03:50:52 PM

Unfounded


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 RETIREMENTFACILITY NUMBER:
306005207
ADMINISTRATOR:GINGER POFACILITY TYPE:
740
ADDRESS:9011 KNOTT AVETELEPHONE:
(714) 821-4130
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY:106CENSUS: 76DATE:
10/26/2023
UNANNOUNCEDTIME BEGAN:
12:36 PM
MET WITH:Director of Operations- Rachelle ReyesTIME COMPLETED:
04:06 PM
ALLEGATION(S):
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Facility staff are not keeping residents clean
Facility is not maintaining a comfortable temperature for residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced initial 10-Day complaint visit to initiate the investigation into the above allegations and to deliver the findings of the investigation. LPA was greeted and granted entry into the facility and met with Director of Operations Rachelle Reyes. LPA explained the reason for the visit.

On today’s visit LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegations, the following was revealed: Seven of eight individuals interviewed denied the allegations. During interviews conducted with residents it was reported that staff assist the residents to stay clean and/or that staff are helpful. Per Resident 1 (R1) he does not need much assistance but that staff assist him with washing his clothes, towels and bedding in order to keep his personal space clean. During interviews conducted with staff, Staff 1 (S1) reported that residents are schedule for three showers per week but that staff will clean and shower the residents as needed.
CONTINUED 9099-C...
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023
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 3
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: 10/26/2023
NARRATIVE
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Regarding the allegation that facility is not maintaining a comfortable temperature for residents in care, the investigation revealed the following: During the initial visit on 10/26/23 LPA toured the Memory Care Unit and observed that the temperature in the hallway was 78.2 degrees Fahrenheit and the temperature in the dining room was 78 degrees Fahrenheit. Per interviews conducted R1 reported that the temperature is comfortable. During interviews conducted with staff it was reported that the Memory Care Unit temperature is always comfortable for the residents and that it gets adjusted depending on the weather.

Therefore, the allegations are deemed UNFOUNDED, meaning the allegations are false, could not have happened and/or are without a reasonable basis.



LPA Ramirez conducted an exit interview with Director of Operations Reyes and a copy of this report was provided to the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3