306005678-3-2-2023-22-AS-MSTC-CPPM7Y-20230307082220

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 03/02/2023
Date Signed: 03/02/2023 04:43:11 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
03/02/2021 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210302083010

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: 135	DATE:	03/02/2023
		UNANNOUNCED	TIME BEGAN:	04:31 PM
MET WITH:	Christine Chon		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff did not obtain medical treatment for resident 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 the allegation listed above. LPA met with Executive Director (ED) Christine Chon and explained the reason for the visit. The investigation into the allegation, staff did not obtain medical treatment for resident in a timely manner, revealed the following. It was reported that Resident 1 (R1) requested the facility make an appointment with their home health aid company to trim their toenails. R1 and staff verify this report. R1 and staff reported that the facility did make an appointment after R1’s request and the appointment was scheduled on 3/1/21, 3 days after R1’s request. Staff reported they offered to contact outside vendors to assist R1, at R1’s own expense, if they wanted the requested service at an earlier date. R1 and staff reported that R1 declined this option. The appointment was rescheduled by R1 and took place on 3/8/21. R1 and staff verified this information. The facility offered to take R1 to urgent care, the ER or to make an appointment with their doctor. R1 verified this report and added they declined the offer. All witnesses interviewed and R1 verified their toenails were trimmed on 3/8/21. The facility acted when R1 made their request and offered to schedule an earlier appointment and to schedule additional appointments but R1 declined.

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: 03/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

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-20210302083010

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: 03/02/2023

NARRATIVE

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The facility offered to take R1 to urgent care or the emergency room to address any concerns R1 had and R1 declined. Based on the evidence gathered the allegation, staff did not obtain medical treatment for resident 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: 03/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

LIC9099 (FAS) - (06/04)

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