306005678-12-22-2022-22-AS-AORZ-CMKUTU-20221229145229

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 12/22/2022
Date Signed: 12/22/2022 04:08:09 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
08/18/2020 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200818082949

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: 124	DATE:	12/22/2022
		UNANNOUNCED	TIME BEGAN:	03:46 PM
MET WITH:	Christine Chon		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff are not allowing resident to communicate to their responsible person.
Staff yell at resident in care.

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 allegations listed above. LPA met with Executive Director Christine Chon and explained the reason for the visit. The investigation revealed the following. It was alleged that staff are not allowing resident to communicate to their responsible party. Staff reported that when someone calls the facility, they make an attempt to connect them with the resident but if the resident does not want to speak on the phone or is unavailable they take a message and notify the supervisor to have the resident return the call. In the case of memory care residents, staff attempt to assist the resident to return the call but they are not forced to return the call. Staff reported that R1 is assisted with the phone and with making calls through Zoom (video call). It was reported by a witness (W1) that when they call the facility they don’t always get to speak to the resident. W1 reported that this does not happen all the time. W1 could not provide dates and times when this took place or the names of staff members they spoke to when they called. Staff reported they do their best to have the resident receive and/or return the call but sometimes people who call hang up before the resident has a chance to speak to them.

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: 12/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022

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-20200818082949

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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W1 reported that they do speak to R1 each week, staff reported that they have seen R1 use their phone and the facility phone to talk to people. It was reported that staff did not afford R1 privacy to make their calls. Staff denied this report. R1 could not verify or refute any of these reports. There is no evidence to corroborate the allegation. Based on the evidence gathered through interviews the allegation, staff are not allowing resident to communicate to their responsible person 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.

Regarding the allegation, staff yell at resident in care, the investigation revealed the following. It was reported that staff in the memory care unit yell at the residents in memory care. W1 stated they have never seen or heard staff yell at a resident but were told by R1 that staff yelled at them. R1 could not verify this report. No specific details such as the date and time were provided with the report. Only one resident (R1) was reported to have been yelled at in memory care. R1 could not verify or refute this allegation. The other 2 residents interviewed could not verify or refute the allegation. Staff reported that none of the residents in memory care have been yelled at or mistreated in any way. None of the evidence gathered through interviews could corroborate the allegation. Based on the evidence gathered the allegation, staff yell at resident in care, 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: 12/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022

LIC9099 (FAS) - (06/04)

Page: 4 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
08/18/2020 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200818082949

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: 88	DATE:	12/22/2022
		UNANNOUNCED	TIME BEGAN:	03:46 PM
MET WITH:	Christine Chon		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Resident was subjected to medical testing without consent from their responsible party.

INVESTIGATION FINDINGS:

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Licensing Program Analsyt (LPA) Joseph Alejandre made an unannounced visit to deliver the findings of the complaint investigation into the allegations listed above. LPA met with Executive Director Christine Chon and explained the reason for the visit. Regarding the allegation, resident was subjected to medical testing without consent from their responsible party, the investigation revealed the following. It was reported that R1 was tested for Covid-19 prior to the facility staff getting permission from the responsible party. Staff reported that R1 was tested for Covid-19 and no one was informed about the testing. The review of files for R1 showed the person who is the Power of Attorney is the Financial Power of Attorney, not the Power of Attorney for Medical or Healthcare decisions. They are the authorized representative for Medi-Cal only, they are not listed on the Admission agreement or any other documents as the responsible party or representative (except as noted above) for the resident, they are listed as the nearest relative on the emergency contact information. Resident is not conserved, and the Public Guardian is not responsible for the resident.

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: 12/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 22-AS-20200818082949

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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The Agency defines a representative as, "an individual who has authority to act on behalf of the resident; including but not limited to, a conservator, guardian, person authorized as agent in the resident's valid advance health care directive, the resident's spouse, registered domestic partner, or family member, a person designated by the resident, or other surrogate decision maker designated consistent with statutory and case law.". R1 does not have anyone who meets that definition. R1 does not have any who is the medical Power of Attorney. The facility did test the resident for Covid-19. Because there is no official representative or responsible party listed for the resident and only a financial Power of Attorney, the allegation, resident was subjected to medical testing without consent from their responsible party 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: 12/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 4