306005678-8-26-2022-22-AS-LADS-CJ2UVV-20220907155545

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 08/26/2022
Date Signed: 08/26/2022 01:18:18 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
08/25/2022 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220825161901

FACILITY NAME:	HARBOR HEIGHTS ASSISTED LIVING & MEMORY CARE		FACILITY NUMBER:	306005678
ADMINISTRATOR:	CHRISTINE CHON		FACILITY TYPE:	740
ADDRESS:	525 W. LA PALMA AVE		TELEPHONE:	(714) 459-3353
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	199	CENSUS: 99	DATE:	08/26/2022
		UNANNOUNCED	TIME BEGAN:	12:01 PM
MET WITH:	Yaylene Mazariegos		TIME COMPLETED:	01:32 PM

ALLEGATION(S):

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Staff not following physician's order.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA was greeted and granted entry by staff. LPA met with Assistant Executive Director Yaylene Mazariegos. LPA explained the reason for the visit. The investigation revealed the following. It was alleged the facility is not following Resident 1's (R1) doctor's order for a wheelchair. The facility and R1 provided a copy of the prescription for a wheel chair. Staff interviewed reported they have contacted R1's insurance and the healthcare provider who supplies wheelchairs and were told R1's insurance would not cover the cost of the wheelchair and they (R1) must pay out of pocket. Interview with R1 verifies this but R1 stated they should be provided a wheelchair. The facility is not required to provide residents with wheelchairs. The facility has reached out to other provides to assist R1 but because of the insurance issues they would not assist. Based on the evidence gathered the allegation, staff not following 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, and a copy of the report provided.

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: 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)

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