306005678-11-4-2021-22-AS-LADS-CFNR88-20220623124732

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 11/04/2021
Date Signed: 11/04/2021 01:18:14 PM

Unsubstantiated

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
08/20/2020 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200820105742

FACILITY NAME:	HARBOR HEIGHTS ASSISTED LIVING & MEMORY CARE		FACILITY NUMBER:	306005678
ADMINISTRATOR:	AHAOMA S. ONYEBUCHI		FACILITY TYPE:	740
ADDRESS:	525 W. LA PALMA AVE		TELEPHONE:	(714) 860-4016
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	199	CENSUS: 48	DATE:	11/04/2021
		UNANNOUNCED	TIME BEGAN:	01:01 PM
MET WITH:	Paul Brown		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Resident's call light system is in disrepair.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings on the above allegation. LPA was greeted and granted entry by Administrator Paul Brown. LPA explained the reason for the visit. The investigation into the allegation, resident's call light system is in disrepair, revealed the following; it was reported that the call light system was not working on 8/19/2020. On 8/27/2020 when the 10-day visit was conducted the call light system was operating. The Administrator reported the facility was having phone issues, but the call light system was working. Staff interviewed did not report any issues with the call light system and they reported they were unaware of any instances of the call light system not working. 4 out of 5 residents interviewed reported they had no issues with the call light system. The Administrator reported that the call light system will be updated after the new phone system is installed. The Administrator stated the current call light system does not keep a record of calls. The Administrator reported that the system is monitored at the front desk and as calls come in they notify the caregivers via radio and the caregivers acknowledge the call and assist the residents and then reset the call the signal system from the resident’s room.

Unsubstantiated

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: 11/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021

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-20200820105742

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: 11/04/2021

NARRATIVE

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The Administrator reported that no one has reported to him any issues with the call light system. It was reported that the front desk staff verified the call light system was not working on 8/19/2020. The unidentified staff who allegedly verified the call light system was not working on 8/19/2020 could not be identified through a schedule review or by interviewing the staff. The evidence gathered could not corroborate the allegation that the call light system was not working on 8/19/2020. Therefore, the allegation, resident's call light system is in disrepair, is deemed unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. 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: 11/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021

LIC9099 (FAS) - (06/04)

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