306005678-12-8-2022-22-AS-LADS-CM5VQ4-20221215153744

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 12/08/2022
Date Signed: 12/08/2022 05:07:15 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
05/13/2021 and conducted by Evaluator Joseph Alejandre

COMPLAINT CONTROL NUMBER: 22-AS-20210513093805

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:	DATE:	12/08/2022
		UNANNOUNCED	TIME BEGAN:	04:46 PM
MET WITH:	Christine Chon		TIME COMPLETED:	05:17 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Residents not being provided their medication in a timely manner.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Joseph Alejandre madke an unannounced visit to deliver the findings of the complaint investigation. LPA met with Executive Director Christine Chon. LPA explained the reason for the visit. The investigation into the allegation, resident not being provided their medication in a timely manner, revealed the following. Resident 1's (R1) medications are handled by the facility. R1 has both routine medications and PRN medications prescribed by his doctor. It was alleged that on 5/13/2021 R1 did not receive their pain medication (PRN, Hydrocodone 325MG Tablet) timely and was made to wait 40 minutes for their medication. 5 out of 5 Staff interviewed reported that R1 received their medication timely after R1 requested it, in compliance with physician’s orders. R1 reported they were made to wait 40 minutes for their medication. Staff reported that the medication requested is on a time schedule and must be administered at least 6 hours after the last dose. Staff reported that the delay (waiting) R1 is experiencing, is the time before the 6 hours from the last dose has elapsed. Staff reported that R1 would wait for the medication close to the medication room, R1 verified this. Staff reported that when the 6 hours were up, they would administer the medication to R1, so R1 received it timely and did not have to wait.

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: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

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 2

Control Number 22-AS-20210513093805

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: 12/08/2022

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

R1 reported that the medication should be administered when he requests it regardless of what the staff say. A review of records shows R1 was prescribed the PRN and it should only be administered once every 6 hours. The medication record showed that R1 received 4 doses of their PRN medication on 5/13/2021. There is no evidence to corroborate the allegation. Based on the evidence gathered the allegation, resident not being provided their medication in a timely manner 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: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2