306005678-12-15-2021-22-AS-LADS-CFNPHM-20220623112006

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 12/15/2021
Date Signed: 12/15/2021 12:10:14 PM

Unfounded

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
12/06/2021 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20211206142035

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: 57	DATE:	12/15/2021
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Shirley Mazariegos		TIME COMPLETED:	12:31 PM

ALLEGATION(S):

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Facility is not providing reasonable accommodations to married couple.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPAs) Joseph Alejandre and Jerome Haley made an unannounced visit to conduct the requires 10-day visit to begin the investigation into the allegation listed above. LPAs were greeted and granted entry to the facility. LPAs met with staff member Shirley Mazariegos. LPAs explained the reason for the visit. The investigation revealed the following: Resident 1 (R1) and Resident 2 (R2) were recently married. R1 and R2 each have their own admission agreement with the facility and live in separate rooms. R1 and R2 are both not current with their rent. Staff and the Administrator verify the facility is in the process of evicting R1 and R2 for nonpayment of rent. R1 and R2 verified they are being evicted. The AD reports that if both parties were current on their rent, they could enter into a new admission agreement where they share the same room. A review of facility records verified R1 and R2 are not current on their rent. Because R1 and R2 are not current on their rent, if the facility entered into a new admission agreement (contract) with R1 and R2 cohabiting it could nullify the previous admission agreements, and then R1 and R2 may not be responsible for the prior unpaid rents due because a new contract was (continued on LIC9099-C).

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: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

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-20211206142035

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: 12/15/2021

NARRATIVE

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(Continued) was agreed upon. Based on the evidence gathered through interviews of residents and staff and through document review, the allegation: Facility is not providing reasonable accommodations to married couple, 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 Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

LIC9099 (FAS) - (06/04)

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