306005678-8-11-2021-22-AS-LADS-C7JRFV-20211006125946

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 08/11/2021
Date Signed: 08/11/2021 04:33:36 PM

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
10/28/2020 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20201028085927

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:	DATE:	08/11/2021
		UNANNOUNCED	TIME BEGAN:	03:55 PM
MET WITH:			TIME COMPLETED:	04:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident was assaulted by another resident.
Facility does not have qualified administrator.
Financial abuse of a resident.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings on the above allegations. LPA was greeted and granted entry by Administrator Paul Brown. LPA explained the reason for the visit. The investigation revealed the following. Resident 1 (R1) reported that he was assaulted by another resident. R1 could not provide any details of the incident. There were no incidents reported to the facility or State Licensing concerning any assaults. R1 could not provide a date or a time or the name of the perpetrator. After a review of documentation and interviewing the staff present there is no evidence to support the allegation. Therefore, the above allegation is deemed Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. In regards to the allegation Facility does not have a qualified Administrator the investigation revealed the following, the administrator of the facility has an administrator's certificate from 2/24/2019 to 2/23/2021 that was renewed prior to expiring and the current certificate is dated 2/24/2021 to 2/23/2021. Both certificates are on file with the Agency. Therefore the allegation, Facility does not have a qualified administrator is deemed unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021

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 2

Control Number 22-AS-20201028085927

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: HARBOR HEIGHTS ASSISTED LIVING & MEMORY CARE	FACILITY NUMBER: 306005678
	VISIT DATE: 08/11/2021

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

In regards to the allegation, Financial abuse of a resident, the investigation revealed the following. R1 had been paying the same amount of rent since the facility was owned and operated by the previous licensed owner. The admission agreement of R1 is still in effect. R1 and the facility verified that the amount listed on the rental agreement is what R1 should be paying but under the prior owner/operator R1 was allowed to pay an amount that is less than the agreed upon rent. The facility informed R1 he is expected to pay the amount listed in the rental agreement. R1 verified that he is aware of the rent amount he must pay but thought the facility would allow him to continue to pay less like the previous owner did. R1 acknowledged that he understood why the facility requested the rent amount and agreed to pay the correct amount of rent each month as stated in the rental agreement. R1 acknowledged that paying the agreed upon rent, even if it is an increase in what he expected to pay or use to pay in the past, is not considered financial abuse. Therefore the allegation, Financial abuse of a resident, is deemed unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted with the Administrator 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: 08/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2