306005678-9-23-2020-22-AS-SSAS-BU6LNL-20201007085429

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 09/23/2020
Date Signed: 09/23/2020 04:14:28 PM

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
06/22/2020 and conducted by Evaluator Kathrina Chin

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200622144716

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: 54	DATE:	09/23/2020
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Paul Brown, Executive Director		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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1) Facility has insufficient staff.
2) Staff are not responding in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Kathrina Chin contacted the facility via telephone for the purpose of presenting the findings of the complaint investigation due to COVID-19 and pre-cautionary measures. LPA Chin identified herself and discussed the findings with Paul Brown, the newly designated Executive Director.

Allegation 1- Facility has insufficient staff.

On June 24, 2020, Sam Onyebuchi, Executive Director at that time provided a tour of the facility via Facetime to LPA Chin and showed all the employees that were working at the facility on that day and observed that there were sufficient staff in all departments such caregivers, Medication Technicians, housekeepers and kitchen staff. Mr. Onyebuchi reported that a new management company took over on June 19, 2020 and he is also hiring new employees. LPA Chin reviewed LIC 500 Personnel/Staff Schedules provided by Mr. Onyebuchi.
(Continued on LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2020

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-20200622144716

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: 09/23/2020

NARRATIVE

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LPA Chin interviewed resident 1 and resident 2. Both residents indicated that there is enough staff working at the facility.

The Department has investigated the complaint alleging that the facility has insufficient staff. Based on the information gathered during the investigation and review of all documents obtained, the allegation 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.

Allegation 2 - Staff are not responding in a timely manner.

On September 23, 2020, LPA Chin interviewed resident 1(R1) and resident 2 (R2). Both residents indicated that there is enough staff working at the facility and staff are responding to call lights right away. R2 said that she just tested the response time this week by pushing the call button and she said that staff responded quickly to her.

The Department has investigated the complaint alleging that staff are not responding in a timely manner. Based on the information gathered during the investigation and review of all documents obtained, the allegation 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 teleconference was conducted with Paul Brown, Executive Director and LPA Chin discussed and read this report. A copy of this report will be provided via email along with the appeal rights. Mr. Brown agreed to confirm the receipt of the document, review the report and return a signed copy.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2020

LIC9099 (FAS) - (06/04)

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