306005678-3-10-2023-22-AS-LADS-CPZTDM-20230317143835

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 03/10/2023
Date Signed: 03/10/2023 01:40:56 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
09/22/2021 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210922095253

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: 138	DATE:	03/10/2023
		UNANNOUNCED	TIME BEGAN:	01:01 PM
MET WITH:	Christine Chon		TIME COMPLETED:	01:55 PM

ALLEGATION(S):

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Staff is not adhering to doctor's orders.

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 allegation listed above. LPA met with Executive Director Christine Chone and explained the reason for the visit. The investigation into the allegation, staff is not adhering to doctor's orders, revealed the following: Resident 1 (R1) was handling their own meds from 9/01/17 to 9/22/21. It was reported that R1 and their responsible party were notified by the former Administrator (Administrator of the facility at the time the complaint was filed) of the facility that R1 was assessed by the facility and was no longer capable of handling their own medication. As a result, the facility was going to charge R1 for medication management. All witnesses interviewed verified this information. R1’s physician’s report (LIC 602A) dated 1/20/21 states R1 can manage their own medication. The facility did not arrange a new assessment by R1’s physician and a new physician’s report (LIC 602A) was not completed. In February 2022 the facility changed their Administrator. R1 and their responsible party reported they were never charged for medication management and in February of 2022 the new facility Administrator contacted R1’s responsible party informed them they would manage R1’s medication and would not be charged.

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: 03/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

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-20210922095253

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: 03/10/2023

NARRATIVE

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Facility staff and R1’s responsible party verified this information. R1 and their responsible party agreed to have the facility manage R1’s medication as part of the basic services. At this time R1’s medications are being managed by the facility, R1, their responsible party and facility staff verified this information. The physician’s report (LIC 602A), which is a required document for all residents, part 16 a states, “able to administer own prescription medications”, and there are spaces to check yes or no and a comment section. Any resident and their responsible party can agree to have the facility manage the resident’s medications even though they are able to administer their own medication. None of the evidence gathered supports the allegation. Therefore, the allegation, staff is not adhering to doctor's orders, 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 interview was conducted, and a copy of the 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: 03/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

LIC9099 (FAS) - (06/04)

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