306005678-10-7-2022-22-AS-MSTC-CKR7UF-20221031215817

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 10/07/2022
Date Signed: 10/07/2022 05:14:50 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
10/05/2022 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20221005152859

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: 106	DATE:	10/07/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Yaylene Mazariegos		TIME COMPLETED:	05:25 PM

ALLEGATION(S):

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Facility failed to serve the same quality of food to all residents.

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 into the allegation, Facility failed to serve the same quality of food to all residents, revealed the following. LPA interviewed staff and residents. 10 out of 10 residents interviewed reported they liked the food and did not have any issues with the quality of the food being served. Staff interviewed reported they had not received any complaints regarding the quality of the food being served. LPA inspected the kitchen and dining room. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand. LPA observed fresh produce and vegetables. LPA observed all refrigerators and freezers were at the proper temperature. LPA observed the kitchen is clean and organized. LPA did not observe any evidence that the food was not good quality. Staff reported that U.S. Foods supplies the dry goods and the produce and vegetables are supplied by Vesta Produce. All of the meals served are made from the same food supply and prepared in the kitchen.

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: 10/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

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-20221005152859

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: 10/07/2022

NARRATIVE

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LPA observed the meals served are well balanced and offer a variety. Lunch was classic meat loaf with mashed potatoes and green beans and dinner was barley vegetable soup and baked Parmesan fish, garden rice and Italian style vegetables. There is no evidence to corroborate the allegation, facility failed to serve the same quality of food to all residents, therefore the allegations 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: 10/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

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
10/05/2022 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20221005152859

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: 106	DATE:	10/07/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Yaylene Mazariegos		TIME COMPLETED:	05:25 PM

ALLEGATION(S):

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Facility Administrator and staff failed to accord dignity to all residents in care.

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 into the allegation, facility Administrator and staff failed to accord dignity to all residents in care, revealed the following; LPA interviewed 11 staff and 10 residents. LPA toured the facility. 10 out of 10 residents reported they had not experienced any staff treating them in a disrespectful manner and not experienced any staff member not according them dignity in their interactions. 11 out of 11 staff interviewed reported that they had not witnessed or participated in any mistreatment of residents and reported all residents are treated with dignity and respect. 10 out of 10 residents reported that they are being well taken care of and have no issues with the facility. No specific details of how residents were not accorded dignity were provided by the complainant. None of the evidence gathered supports the allegation. Based on the interviews conducted the allegation, facility Administrator and staff failed to accord dignity to all residents in care,

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: 10/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

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-20221005152859

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: 10/07/2022

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	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.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 4