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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306005678
Report Date:
09/30/2021
Date Signed:
09/30/2021 04:49:13 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:
HARBOR HEIGHTS ASSISTED LIVING & MEMORY CARE
FACILITY NUMBER:
306005678
ADMINISTRATOR:
PAUL BROWN
FACILITY TYPE:
740
ADDRESS:
525 W. LA PALMA AVE
TELEPHONE:
(714) 459-3353
CITY:
ANAHEIM
STATE:
CA
ZIP CODE:
92801
CAPACITY:
199
CENSUS:
50
DATE:
09/30/2021
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
02:31 PM
MET WITH:
Paul Brown
TIME COMPLETED:
05:05 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was greeted and granted entry by staff. LPA observed all staff wearing masks. LPA met with Administrator Paul Brown. LPA explained the reason for the visit. Facility is one building with 3 floors. There is a memory care unit and an assisted living area. The capacity is for 199 residents. The 3rd floor is currently unoccupied. The last fire drill took place on July 4th 2021. The fire monitoring system was last tested on 5/18/21. LPA and Administrator toured the building. LPA observed the medication room. All medications were secured and inaccessible to residents. LPA observed residents in memory care participating in music activities with instruments. LPA and Administrator toured the kitchen and dining room. LPA observed 2 day perishable and 7 day non-perishable food supply on hand. The kitchen and dining room were clean and well organized. LPA observed there is a fountain in the central courtyard of the building. The fountain is surround by plants and is inaccessible to residents. There is outdoor area at the back of the facility for residents to go outside. LPA did not observe any obstacles or hazards inside or outside of the building. LPA observed emergency evacuation chairs at each stairwell. All fire extinguishers were fully charged. LPA consulted with Administrator about the RCFE inspection tool use of Guardian. Facility has submitted a mitigation plan that is pending approval. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME:
Luz Adams
TELEPHONE:
(714) 703-2855
LICENSING EVALUATOR NAME:
Joseph Alejandre
TELEPHONE:
(951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE:
09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/30/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
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