306005678-12-22-2022-22-AS-AORZ-CMKV3Y-20221229150530

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 12/22/2022
Date Signed: 12/22/2022 03:43:56 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
11/30/2020 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20201130091349

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: 124	DATE:	12/22/2022
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Christine Chon		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Facility staff refused to re-order a resident's medications.
Administrator will not accept a doctor's prescription order for a wheelchair.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the complaint investigation findings for the allegations listed above. LPA met with Executive Director Christine Chon and explained the reason for the visit. The investigation into the allegation, facility staff refused to re-order a resident's medications, revealed the following. It was alleged that Resident 1’s (R1) medications, Azelastine HCL 0.05% drops, Clindamycin %1 topical solution, Erythromycin-Benzoyl gel 3-5% and Levicyn spray 8oz. ran out on 11/27/20, resulting in R1 not receiving any of the 4 medications listed above. Staff reported that R1 did not miss any medications and that for routine medications prescriptions that are continued are delivered regularly before they run out and for PRN medications staff would contact the pharmacy for a refill before they run out. A review of R1’s physician’s orders and medication administration record showed that Azelastine HCL 0.05% is prescribed and was administered as prescribed twice a day on 11/27/20. The Clindamycin %1 topical solution was not prescribed for November 2020. R1 was prescribed Clindamycin HCL 300 MG tablet but it was discontinued in November 19, 2020. Erythromycin-Benzoyl gel 3-5% was administered as prescribed twice a day on 11/27/20. R1 was not prescribed Levicyn spray in November 2020,

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: 12/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022

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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Control Number 22-AS-20201130091349

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: 12/22/2022

NARRATIVE

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it was not listed on his physician’s orders for November 2020 It was reported that R1 was prescribed the 4 medications listed above and the facility ran out of all of them on 11/27/20 and they did not receive them until two days later. Staff reported that R1 did not run out of any medications in November 2020. The record review shows R1 did not run out of any medications and was administered Azelastine HCL 0.05% and Erythromycin-Benzoyl gel 3-5% as prescribed and that Clindamycin %1 topical solution and Levicyn spray were not prescribed for R1. It was alleged that in addition to medications listed above the facility failed to administer Azelastine HCL 0.05% and Ketoconazole 2% cream and to order refills for both prescriptions on, or around 5/7/2021. Staff reported that R1 has not missed any medications and none of their medications have run out. A review of R1’s physician’s orders and medication administration record shows that the two medications, Ketoconazole 2% cream and Azelastine HCL 0.05% were administered as prescribed for May 2021. Based on the information provided the allegation, facility staff refused to re-order a resident's medications, is deemed unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

In regard to the allegation, administrator will not accept a doctor's prescription order for a wheelchair, the investigation revealed the following. R1 was provided a wheelchair free of charge on or around 8/11/20 by the facility. Facility staff and R1 verified this information. It was reported that the Administrator is not assisting R1 in getting a wheelchair. A review of records shows R1 has a recent prescription for a wheelchair. The Administrator reported that R1’s prescription for a wheelchair was not honored by CalOptima and that he was informed that R1 would have to pay for wheelchair out of pocket. The Administrator reported they contacted 2 medical supply companies, and both informed the Administrator that insurance would not cover the expense and the cost would be out of pocket for R1. R1 verified this information. Medicare only covers the cost of a wheelchair once every 5 years. R1 reported they received their original wheelchair sometime in 2019. This information could not be verified but based on the information gathered from R1 and facility staff, R1 most likely received their original wheelchair sometime in the last 5 years. The facility assisted R1 in attempting to get a new wheelchair. The facility previously provided R1 with a wheelchair free of cost. The facility is not required to provide R1 a wheelchair. R1 reported that their current wheelchair is working and meets their needs. Based on the information provided the allegation, administrator will not accept a doctor's prescription order for a wheelchair, is deemed unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022

LIC9099 (FAS) - (06/04)

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