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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 01/25/2024
Date Signed: 01/25/2024 12:59:00 PM

Substantiated


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
05/20/2021 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20210520120731
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: 177DATE:
01/25/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Christine ChonTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Facility is refusing to serve meals in a dining area where residents are encouraged to have meals with other residents.
INVESTIGATION FINDINGS:
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LIcensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings of the complaint investigation for the allegation listed above. LPA met with Executive Director Christine Chon and explained the reason for the visit. It was alleged that the facility was refusing to serve meals in the dining area where residents are encouraged to have meals with other residents. The investigation revealed the following. The facility opened the dining room after PIN # 21-17-ASC dated 3/19/2021 was released that stated on page 8, “Residents who are not on isolation precautions or quarantine may eat in the same room (including same table) and participate in group activities with physical distancing among residents, appropriate hand hygiene, and face coverings (except when eating or drinking), even for fully vaccinated residents.”. Facility staff and residents interviewed reported that the dining room was opened with the following 2 rules, only 2 people per table sitting across from each other diagonally and masks must be worn except when eating.
7 out of 7 residents interviewed reported that shortly after the dining room was opened in March 2021 it was closed again.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
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 5
Control Number 22-AS-20210520120731
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: 01/25/2024
NARRATIVE
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 None of the staff or residents interviewed could remember the date the dining room was closed but all agreed it was sometime in April 2021. The Administrator reported that the dining room was closed again because the residents would not follow the two people per table rule and would not social distance and none of the residents would wear a mask when entering or leaving the dining room. 7 out of 7 residents interviewed denied this report. 4 out of 4 staff interviewed reported that most of the residents followed the 2 rules but there were always 2 or 3 residents per meal that violated the rules. On 5/14/2021 PIN 21-17.2-ASC (which supersedes prior PINs issued) was issued which stated on page 8, “Residents who are not on isolation precautions or quarantine may eat in the same room and same table and participate in group activities within six (6) feet of each other and with appropriate hand hygiene.”. In addition, PIN 21-17.2 stated, “If residents who are not fully vaccinated are present in a communal area (e.g., dining room or activity area), then all participants should wear a well-fitting face covering (except while eating or drinking).”. PIN 21-17.2 also stated, “It is important to note that licensees cannot keep residents from participating in communal dining or group activities, or keep residents separated during communal dining or a group activity, based on vaccination status. Residents who are not on isolation precautions or quarantine retain the right to participate in communal dining and group activities, regardless of their vaccination status.”. All staff and residents interviewed reported the dining room was opened on or around July 7, 2021. The dining room was required to be open beginning on 5/14/2021 with no restrictions except for those who were on isolation or quarantine. All staff and residents interviewed verified the dining room was closed before 5/14/2021 and did not open until July 7, 2021.

Based on the evidence gathered the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. Violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8.

An exit interview was conducted and a copy of the report along with appeal rights was provided.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20210520120731
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/26/2024
Section Cited
CCR
87468.1
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To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement was not met as evidenced by,
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Facility is to not close the dining unless directed by the proper authority. Facility is to retrain staff on personal rights of all residents in facilities.
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The facility closed the dining room until 7/07/2021, when it was required to be open begining 5/14/2021. This posed a potential threat to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
05/20/2021 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20210520120731

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: 177DATE:
01/25/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Christine ChonTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Facility does not maintain adequate staffing to meet residents needs.
Facility does not maintain adequate furniture to meet residents 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 for the allegation listed above. LPA met with Executive Director Christine Chon and explained the reason for the visit. The investigation into the allegation, facility does not maintain adequate staffing to meet residents’ needs, revealed the following. It was alleged that one of the reasons the dining room was closed was because there were not enough staff to open the dining room. The Administrator reported that the facility has enough staff to care for the residents. The Administrator reported that it requires the same number of staff to prepare and serve meals whether the dining room is open or not. The Administrator reported the dining room was closed because the residents could not follow the social distancing rules and kept eating in large groups at the same tables. 4 out of 4 staff interviewed reported there are enough staff to properly care for the residents. 3 out of 7 residents interviewed reported that there should be more staff but could not provide any examples of when more staff were needed. It was alleged that staff do not respond to calls for assistance.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20210520120731
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: 01/25/2024
NARRATIVE
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1 out of 7 residents interviewed reported that staff do respond immediately to calls for assistance. Resident 1 could not provide any details regarding this report. 4 out of 4 staff interviewed reported that all calls for assistance are answered in a timely manner. Based on the information gathered through interviews the allegation 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.

The investigation into the allegation, facility does not maintain adequate furniture to meet residents’ needs, revealed the following. It was reported that the facility did not have enough furniture in the dining room to accommodate the number of residents living in the facility. 7 out of 7 residents interviewed reported they did not have any issues with the furniture in the dining room and there was always a place to sit in the dining room no matter what time they went to eat. 4 out of 4 staff interviewed reported that when the dining room was open the furniture was constantly being moved around by residents but there were always plenty of chairs and tables in the dining room. LPA observed during the initial 10-day visit there was furniture in the dining room to meet the needs of the residents. The Administrator reported that there is plenty of furniture for the entire facility including the dining room. Based on the information gathered the allegation is 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 the Administrator was provided with a copy of the report.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5