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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 04/12/2023
Date Signed: 04/12/2023 04:53:26 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
03/02/2023 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230302151956
FACILITY NAME:HARBOR HEIGHTS ASSISTED LIVING & MEMORY CAREFACILITY NUMBER:
306005678
ADMINISTRATOR:CHRISTINE CHONFACILITY TYPE:
740
ADDRESS:525 W. LA PALMA AVETELEPHONE:
(714) 459-3353
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:199CENSUS: 143DATE:
04/12/2023
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Christine ChonTIME COMPLETED:
04:17 PM
ALLEGATION(S):
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9
Resident sustained pressure injury while in care.
Staff failed to meet resident's needs
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 into the allegation, resident sustained a pressure injury while in care, revealed the following. Resident 1 (R1) had a doctor's appointment on 3/14/23. R1 reported they had no issues regarding pressure injuries. A doctor's note dated 3/14/23 states R1 does not have any pressure injuries. Based on the evidence gathered the allegation is deemed unfounded, meaning the allegation is false could not have happened and/or is without a reasonable basis. In regards to the allegation, staff failed to meet resident's needs, the investigation revealed the following. It was alleged that the facility did not assist the resident in getting a new wheelchair. Facility staff reported that they received the prescription for a wheelchair but the insurance denied the claim and reported R1 received a wheelchair on 7/13/21. Facility staff provided the LPA with the document. Facility staff attempted to get R1 a new wheelchair but the claim was deniedby insurance. The facility is not responsible for providing R1 a wheelchair. R1 reported they needed a new wheelchair but understood why insurance will not provide one. (Continued)
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: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
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-20230302151956
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: 04/12/2023
NARRATIVE
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Based on the evidence gathered the allegation, staff failed to meet resident's needs, 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: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2