306005678-8-26-2022-22-AS-LADS-CJS6W3-20220930210941

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 08/26/2022
Date Signed: 08/26/2022 12:58:57 PM

Unsubstantiated

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
08/16/2022 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220816121139

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: 99	DATE:	08/26/2022
		UNANNOUNCED	TIME BEGAN:	10:01 AM
MET WITH:	Yaylene Mazariegos		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff do not ensure facility is free from pests.

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 allegations 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. LPA Alejandre interviewed 5 staff and 4 residents. All staff were wearing masks. LPA and Assistant Executive Director toured the facility. LPA inspected 6 resident rooms, 2 on each floor and 6 storage rooms, 2 on each floor and 2 stairwells. LPA observed an emergency evacuation chair at each stairwell. LPA inspected the kitchen and dining room. LPA toured the outside of the building. LPA did not observe any evidence of insects or vermin. Only one person interviewed reported seeing an insect once but could not provide the date or time. The facility provided documentation that shows they have routine pest control spraying monthly. Based on the evidence the allegation, staff do not ensure facility is free from pests, is deemed unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and a copy of the report provided.

Unsubstantiated

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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