306005678-8-26-2022-22-AS-LADS-CHSUF2-20220830153159

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 08/26/2022
Date Signed: 08/26/2022 12:07:25 PM

Substantiated

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
09/10/2021 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210910161350

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: 70	DATE:	08/26/2022
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Christine Chon		TIME COMPLETED:	09:35 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not answer residents call button in a timely manner.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings of the complaint investigation into the allegation listed above. LPA was greeted and granted entry by staff. LPA met with Administrator Christine Chon. LPA explained the reason for the visit. The investigation into the allegation, staff did not answer resident's call button in a timely manner, revealed the following; it was reported that a Resident (R1) used the signal system to call for assistance at 11:30pm on 9/9/2021 and staff did not respond so R1 contacted the front desk using a cell phone. Staff reported that a resident called the front desk using a cell phone at that time but there was no record on the call system log that anyone called at around 11:30 pm. on 9/9/2021. R1 and Staff both reported that during the cell phone call to the front desk around 11:30 pm on 9/9/2021, R1 did not request assistance. A review of the call log shows there were 11 calls using the signal system on 9/9/2021 and 7 calls on 9/10/2021 from 12:00 am to 10:53 am. The call system log shows R1 triggered the call system 3 times, once on 9/9/2021 at 2:32 pm and it was not cleared until 1 hour and 45 minutes later, the note on the entry showed R1 was ok. (Continued on LIC 9099C)

Substantiated

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: 08/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022

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-20210910161350

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: 08/26/2022

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
26
27
28
29
30
31
32

R1 triggered the call system twice on 9/10/2021, once at 1:54 am and it was cleared 2 hours and 43 minutes later, note on the entry showed R1 needed help opening Advil. Then immediately after that call was cleared from the signal system, R1 requested assistance once more using the call system at 4:38 am. The call for assistance was cleared 3 minutes later. The note on the call log was, “test”. R1 reported they did not remember the 3 calls on the call system log for 9/09/2021 and 9/10/21, but insisted they called using the call system at 11:30 pm on 9/9/2021. Other residents interviewed who used the signal system on 9/9/2021 to 9/10/2021 reported staff responded to the calls promptly. Staff verified this report. The signal system call log shows all calls recorded from residents on 9/9/2021 to 9/10/2021 at 10:53 am. were resolved (answered) by staff. The call log does not show any calls at 11:30 pm on 9/9/2021. The call log record shows R1 did request help via the call system 3 times on 9/9/2021 and 9/10/2021 and only 1 of the 3 calls was answered in less than an hour and a half. Based on information gathered through record review and interviews the preponderance of evidence standard has been met, therefore, the allegation, staff did not answer residents call button in a timely manner, is found to be SUBSTANTIATED. Violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report along with citation and Appeal Rights (LIC 9058 01/16) was provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 22-AS-20210910161350

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/26/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/27/2022 Section Cited CCR 87464(f)(1)	1 2 3 4 5 6 7	Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not being met as evidenced by:	1 2 3 4 5 6 7	Licensee stated they will train all care staff on the need/importance of responding to the call system timely and ensure all calls are cleared after assistance has been provided. Licensee to forward proof to LPA by POC due date.
	8 9 10 11 12 13 14	a record review showed staff took 1 hour and 45 minutes on 9/9/21 and 2 hours and 43 minutes on 9/10/21 to answer R1’s request for assistance using the signal/call system, which poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3