306005678-3-26-2021-22-AS-LADS-C25RLV-20210416130747

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 03/26/2021
Date Signed: 03/26/2021 03:45:39 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
07/21/2020 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200721154512

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: 47	DATE:	03/26/2021
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Paul Brown		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not give resident their medication.
Facility staff not meeting residents needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Joseph Alejandre contacted the facility via telephone for the purpose of delivering the findings of the complaint investigation due to COVID-19 pre-cautionary measures. LPA Alejandre identified himself and discussed the findings with Administrator Paul Brown. In regards to the allegation; Staff did not give resident their medication; the investigation revealed the following. Resident 1 (R1) has numerous PRN (as needed) medications which are all documented by the facility. LPA reviewed all of R1's medications and medication administration record (MAR). LPA did not discover any discrepancies. LPA verified that some of R1's medications are limited to once every 6 hours. R1 verified they did receive their medication timely and did not receive more medication than prescribed. Staff reported that medication is only administered as prescribed. All of the evidence gathered contradicts the allegation. Therefore, 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; Facility staff not meeting resident's needs, the investigation revealed the following. It was alleged that the Facility took R1's towels without permission and did not return them for 9 hours. Staff reported that R1's laundry including towels are taken once a week, usually on Wednesday.

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: 03/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021

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-20200721154512

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: 03/26/2021

NARRATIVE

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Staff reported that Wednesday is the day laundry is done for R1 since it is part of the service he receives. Staff reported that laundry is picked up between 7 and 9 am and then returned between 2 and 3 pm. Staff reported that laundry is not kept overnight and the longest they usually have anyone's laundry is around 8 hours. R1 reported that he does need his laundry done and has given permission to have his laundry washed, he just does not like the time it takes to do the laundry. R1 reported that he does have all of his laundry items including his towels. None of the evidence gathered supports the allegation, the evidence contradicts the allegation. Therefore, the allegation is deemed UNFOUNDED, meaning the allegation is false could not have happened and/or is without a reasonable basis. An exit interview was conducted with the Administrator and LPA discussed and read this report. A copy of this report was provided via email, an email read receipt confirms receiving these documents. Administrator agreed to review the report and return a signed copy.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021

LIC9099 (FAS) - (06/04)

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