306005678-5-25-2022-22-AS-LADS-CFUK44-20220629073344

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 05/25/2022
Date Signed: 05/25/2022 05:03:36 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
08/27/2020 and conducted by Evaluator Joseph Alejandre

COMPLAINT CONTROL NUMBER: 22-AS-20200827154344

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: 78	DATE:	05/25/2022
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Patricia Rager		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Staff did not follow physician's order.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings of the investigation into the allegation listed above. LPA was greeted and granted entry to the facility. LPA met with Administratror Patty Rager. LPA explained the reason for the visit. The investigation into the allegation, staff did not follow physician's order, revealed the following; LPA conducted the 10-day visit on 9/8/2020 via FaceTime due to Covid-19 precautionary measures. LPA interviewed staff and the Administrator. LPA interviewed Resident 1’s (R1). LPA reviewed R1 medication administration records (MAR) and R1’s physician’s orders listing R1’s prescribed medications. It was reported that R1 was not receiving phosphorus 3 times a day. A review of medication records shows R1 was not prescribed phosphorus. R1 was prescribed Sevelamer Carbonate 800 MG tablet, which is used to control phosphorus levels, 3 times a day. Staff interviewed reported that R1 has been administered their medication as prescribed. The MAR for July and August of 2020 show Sevelamer Carbonate was administered 3 times a day. It was alleged that the facility staff was not administering R1’s Metolazone 2.5 MG tablet (once a day) 30 minutes before their Furosemide 40 MG tablets (2 tablets once a day at 8:00 am). Staff reported that R1’s medication is administered as prescribed at the proper time.

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: 05/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022

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-20200827154344

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: 05/25/2022

NARRATIVE

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A review of the MAR for July and August 2020 confirm this. It was reported that R1’s physician changed R1’s prescription for Furosemide 40 MG tablets because staff was not providing the medication timely as required. This was reported to have taken place on 8/24/2020. A review of the MAR for September 2020 does not corroborate this report. A review of R1’s medication records show that there were no changes to their medication from July 1, 2020 to September 30, 2020, except for the addition of Folic Acid 1 MG tablet. It was reported that the facility requested R1 switch pharmacies so their medication would be provided in bubble packs. R1 and facility staff verify this report. R1 verified the facility did request a change of pharmacy but they did not force the issue and R1’s pharmacy was not changed because R1 informed the facility they did not want the change. The facility is not prohibited from requesting a pharmacy change for their residents and the facility honored R1’s request. Based on the evidence gathered the allegation, staff did not follow physician's order, is deemed UNFOUNDED, meaning the allegation is false could not have happened and/or is without a reasonable basis. An exit interview was conducted with the Administrator and a copy of this report was provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022

LIC9099 (FAS) - (06/04)

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