<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306005678
Report Date:
08/19/2022
Date Signed:
08/19/2022 03:22:01 PM
Document Has Been Signed on
08/19/2022 03:22 PM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
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
ADMINISTRATOR:
PATRICIA RAGER
FACILITY TYPE:
740
ADDRESS:
525 W. LA PALMA AVE
TELEPHONE:
(714) 459-3353
CITY:
ANAHEIM
STATE:
CA
ZIP CODE:
92801
CAPACITY:
199
CENSUS:
95
DATE:
08/19/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
01:16 PM
MET WITH:
Christine Chon
TIME COMPLETED:
03:35 PM
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
Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was greeted and granted entry by staff. LPA observed all staff wearing masks. LPA met with Administrator Christine Chon. Christine Chon has an Administrator's certificate that expires on 10/4/23. LPA explained the reason for the visit. Facility is one building with 3 floors. There is a memory care unit and an assisted living area. The memory care is on the first and second floor on the east side of the building away from Harbor BLVD. The capacity is for 199 residents. The 3rd floor is currently unoccupied. The last fire drill took place on 7/1/22. Fire extinguishers were inspected on 2/25/22 and are fully charged. The fire sprinkler system was checked/inspected on 4/24/22. LPA and Administrator toured the building. Smoke detectors in resident rooms tested operational. LPA observed the medication rooms and all medications were secured and inaccessible to residents in both the memory care and assisted living areas of the facility. LPA observed the resident rooms in memory care (1st and 2nd floors) had the required furnishings. Hot water measured 104.5 degrees Fahrenheit in room M109 and 107.2 degrees Fahrenheit in room A108. Smoke detectors in both rooms tested operational. LPA observed the resident rooms in assisted living on the first and second floor had the required furnishings. LPA observed a 30 day supply of PPE in a storage closet. LPA and Administrator toured the kitchen and dining room. LPA observed a 2 day perishable and 7 day supply of non-perishable food on hand. The kitchen and dining room were clean and well organized. LPA observed there is a fountain in the central courtyard of the building. The fountain is surround by plants and is inaccessible to residents. There is a library and a theater room for residents and visitors. There is outdoor area at the back of the facility for residents to go outside. LPA did not observe any obstacles or hazards inside or outside of the facility. LPA observed emergency evacuation chairs at each stairwell. LPA consulted with Administrator about the RCFE inspection tool and continued Covid-19 mitigation. No deficiencies are being cited as a result of this visit. 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:
08/19/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/19/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
1