306005678-9-8-2022-22-AS-MSTC-CKR85M-20221031221259

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 09/08/2022
Date Signed: 09/08/2022 04:53:21 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
08/17/2020 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200817152224

FACILITY NAME:	HARBOR HEIGHTS ASSISTED LIVING & MEMORY CARE		FACILITY NUMBER:	306005678
ADMINISTRATOR:	AHAOMA S. ONYEBUCHI		FACILITY TYPE:	740
ADDRESS:	525 W. LA PALMA AVE		TELEPHONE:	(714) 860-4016
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	199	CENSUS: 102	DATE:	09/08/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Christine Chon		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff allow resident to urinate on the floor.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings of the complaint investigation. LPA met with Administrator Christine Chon and explained the reason for the visit. The investigation into the allegation, staff allow resident to urinate on the floor, revealed the following. It was alleged there was a resident (R1) who has had bathroom accidents at the facility. Interviews with staff and R1 verified this. 1 out of 7 residents (this resident is identified as R2) interviewed had noticed R1 had a bathroom accident at the facility that required cleaning. 6 out of the 7 residents interviewed reported they were unaware of any such issues. Staff reported that they always assist residents and will help them clean up and change clothes. R1 verified this. Staff and R1 agreed that they provide assistance timely within 15 minutes of issues being reported. Staff reported that if the floor in the facility needed to be cleaned because of a bathroom accident, it would be cleaned immediately. 6 out of 7 residents reported they have never seen any puddles or a wet floor in the facility except when the floor was being cleaned. 1 out of 5 staff (this staff member is identified as Staff 1 for this report) interviewed reported cleaning a bathroom accident on the floor.

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: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

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-20200817152224

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: 09/08/2022

NARRATIVE

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Staff 1 reported it was cleaned with 5 minutes of being reported. R2, Care Staff, Staff 1 and R1 could not agree on the date, the time or the number of bathroom accidents R1 has had at the facility. All agreed it was infrequent but could not provide specific details. No other reports from staff or residents have been made about bathroom accidents at the facility or to the Agency. Based on the evidence gathered the allegation, staff allow resident to urinate on the floor is deemed Unsubstantiated , meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and a copy of this 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: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

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
08/17/2020 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200817152224

FACILITY NAME:	HARBOR HEIGHTS ASSISTED LIVING & MEMORY CARE		FACILITY NUMBER:	306005678
ADMINISTRATOR:	AHAOMA S. ONYEBUCHI		FACILITY TYPE:	740
ADDRESS:	525 W. LA PALMA AVE		TELEPHONE:	(714) 860-4016
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	199	CENSUS: 102	DATE:	09/08/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Christine Chon		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff do not keep facility clean.
Staff leave resident in soiled clothing.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre met with Administrator Christine Chon to deliver the findings of the investigation into the allegations listed above. The investigation into the allegation, staff do not keep facility clean, revealed the following. LPA toured the facility and the facility was clean. LPA did not observe any areas of the facility that were not clean. 6 out of 7 residents interviewed reported the facility was clean and they had no issues with how the facility was maintained. Staff interviewed reported that the facility is cleaned every day. Based on the information gathered the allegation, staff do not keep facility clean is deemed, Unfounded meaning the allegation is false could not have happened and/or is without a reasonable basis.

In regards to the allegation, staff leave resident in soiled clothing, the investigation revealed the following. Staff interviewed reported that any resident in need of help, like changing clothes is always assisted. Staff reported R1 has never been left in soiled clothing and is helped in a timely manner. R1 verified this report. Staff and R1 agreed that they provide assistance timely within 15 minutes of issues being reported.

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: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

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-20200817152224

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: 09/08/2022

NARRATIVE

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6 out of 7 residents interviewed have never seen another resident in soiled clothing and were unaware of any such issues. The Administrator reported that no residents have reported any such issues. None of the evidence gathered supports the allegation. The subject of the allegation, R1 refutes the allegation. Based on the evidence gathered the allegation, staff leave resident in soiled clothing 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 this 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: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

LIC9099 (FAS) - (06/04)

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