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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 02/07/2022
Date Signed: 02/07/2022 01:06:55 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
01/31/2022 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220131150010
FACILITY NAME:HARBOR HEIGHTS ASSISTED LIVING & MEMORY CAREFACILITY NUMBER:
306005678
ADMINISTRATOR:PAUL BROWNFACILITY TYPE:
740
ADDRESS:525 W. LA PALMA AVETELEPHONE:
(714) 459-3353
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:199CENSUS: 62DATE:
02/07/2022
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Paul BrownTIME COMPLETED:
01:21 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff does not assist residents with refilling PRN medication.
Facility is in disrepair.
INVESTIGATION FINDINGS:
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2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegations listed above. LPA was screened for Covid-19 symptoms and granted entry by staff. LPA met with Executive Director Paul Brown and explained the reason for the visit. The investigation revealed the following; Resident 1's (R1) PRN medication for Temazepam was discontinued by R1's physician on 12/24/21. The physician reported to the facility that the medication must be discontinued. R1 reported that the physician explained this to them. The facility cannot go against the physician's orders and must administer all medication as prescribedfor all residents. R1 and the facility both verify they have spoken to the physician and understand the discontinuance order. Based the evidence gathered through interviews and a review of the medication records the allegation, staff does not assist residents with refilling PRN medication, is deemed UNFOUNDED, meaning the allegation is false, could not have happened and/or is without a reasonable basis. In regards to the allegation, facility is in disrepair, the investigation revealed the following. The hot water in the facility is available and meets the temperature requirements. LPA observed the facility is in good repair and did not observe any deficiencies in the physical plant, including plumbing during the tour of the facility.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2022
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-20220131150010
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: 02/07/2022
NARRATIVE
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Staff and residents interviewed did not report any issues with facility maintenance. Based on the evidence gathered through observation and interviews the allegation is deemed UNFOUNDED, meaning the allegation is false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of the report provided.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
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
01/31/2022 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220131150010

FACILITY NAME:HARBOR HEIGHTS ASSISTED LIVING & MEMORY CAREFACILITY NUMBER:
306005678
ADMINISTRATOR:PAUL BROWNFACILITY TYPE:
740
ADDRESS:525 W. LA PALMA AVETELEPHONE:
(714) 459-3353
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:199CENSUS: 52DATE:
02/07/2022
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Paul BrownTIME COMPLETED:
01:21 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility does not have a sufficient amount of hot water.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
The investigation into the allegation, facility does not have a sufficient amount of hot water revealed the following. LPA measured the hot water in rooms 104 (office), 101, 107, 117, 211 and 219. All of the rooms had hot water that measured between 115 and 120 degrees Fahrenheit. It was alleged the facility did not have sufficient hot water. None of the residents interviewed reported an issue with the hot water. It is possible that there was a lack of hot water on one occasion that prompted the allegation to be reported but none of the evidence supports the allegations. Based on the evidence the allegation, facility does not have a sufficient amount of hot water, 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.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3