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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 01/05/2023
Date Signed: 01/05/2023 03:16:27 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
08/11/2021 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20210811084006
FACILITY NAME:HARBOR HEIGHTS ASSISTED LIVING & MEMORY CAREFACILITY NUMBER:
306005678
ADMINISTRATOR:PAUL BROWNFACILITY TYPE:
740
ADDRESS:525 W. LA PALMA AVETELEPHONE:
(714) 459-3353
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:199CENSUS: 125DATE:
01/05/2023
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Christine ChonTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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9
Facility did not provide resident's representative a copy of resident's records in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings of complaint investigation into the allegation listed above. LPA met with Executive Director Christine Chon. The investigation into the allegation revealed the following. It was alleged that; facility did not provide resident's representative a copy of resident's records in a timely manner. Resident 1 (R1) was not at the facility and could not be reached. LPA attempted to contact Responsible Party 1 (RP 1) numerous times, but no contact was ever made. The only witness interviewed who was not facility staff had no direct knowledge of the request and never witnessed RP 1 requesting documents from the facility. The facility Administrator reported that RP 1 requested a copy of R1’s file when they spoke on the phone. The Administrator reported that he informed RP 1 they must specify in an email or a letter what specific items he is requesting because resident files can be very large and include information the requestor may not need or want since the file has information that is more than 5 years old. The Administrator reported that after that conversation he never spoke to RP 1 again and never received an email requesting any documents.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2023
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-20210811084006
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: 01/05/2023
NARRATIVE
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Based on the evidence gathered. the allegation, facility did not provide resident's representative a copy of resident's records 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 AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2