306005678-8-26-2022-22-AS-LADS-CJXUNF-20221006154352

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 08/26/2022
Date Signed: 08/26/2022 12:41:30 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
09/07/2021 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210907082332

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: 99	DATE:	08/26/2022
		UNANNOUNCED	TIME BEGAN:	09:36 AM
MET WITH:	Yaylene Mazariegos		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility failed to accommodate residents.

INVESTIGATION FINDINGS:

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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 Assistant Executive Director Yaylene Mazariegos. LPA explained the reason for the visit. The investigation into the allegation, facility failed to accommodate residents, revealed the following. It was alleged the facility failed to accommodate residents regarding keeping their belongings (furniture). Resident 1 (R1) and Resident 2 (R2) reported that they were asked to get rid of some of their furniture because they were going to share a room. The required furnishings for a room in an RCFE for each resident are (CCR: 87307(a)(3)(A), (B) & (E)), a bed, chair, nightstand, lamp, chest of drawers and a minimum of 8 cubic feet of drawer space per resident. An inspection of the new rooms to be shared for residents showed the shared rooms will accommodate both residents and have enough space for each resident to move freely in the room. The new rooms will accommodate the required furnishings for each resident and have more than 8 cubic feet of storage space for each resident. R1 and R2 agreed they each have more furniture than the amount required to be provided by the facility.

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)

Page: 1 of 4

Control Number 22-AS-20210907082332

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

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The Administrator, R1 and R2 verified they agreed to live in a shared room. R1 and R2 had previously lived in private rooms. After the remodel residents agreed, including R1 and R2 they would move into shared rooms. The facility is not required to allow for additional furnishings beyond the regulatory requirements. The facility is not required to offer additional storage to residents. Both R1 and R2 agreed to shared rooms and the facility is providing a shared room that will accommodate the required furnishings for R1 and R2. Based on the evidence gathered the allegation, facility failed to accommodate residents, 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.

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

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
09/07/2021 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210907082332

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: 99	DATE:	08/26/2022
		UNANNOUNCED	TIME BEGAN:	09:36 AM
MET WITH:	Yaylene Mazariegos		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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9

Facility threatened to evict residents.

INVESTIGATION FINDINGS:

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5
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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 Assistant Executive Director Yaylene Mazariegos. LPA explained the reason for the visit. The investigation into the allegation, facility threatened to evict residents, revealed the following. Residents at the facility were asked by the facility to move into shared rooms due to the remodeling of the facility, which was approved by the local fire authority and the Agency (CCL). Staff and residents verified this information. It was alleged that the Administrator threatened to evict residents who did not comply with moving into the newly assigned rooms. Interviews with the Administrator, 3 staff and 6 residents did not corroborate the allegation. A review of reports and correspondence received from the facility did not show any eviction notices at the time the complaint was filed. The Administrator reported no eviction notices have been issued in the last month. LPA verified no eviction notices have been received by the Regional Office for the facility.

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)

Page: 3 of 4

Control Number 22-AS-20210907082332

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	Based on the information gathered during the investigation, the allegation, facility threatened to evict residents, 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 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: 08/26/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 4