306005678-2-22-2024-22-AS-LMOA-D4U6U6-20240430210636

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 02/22/2024
Date Signed: 02/22/2024 05:01:29 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
02/15/2024 and conducted by Evaluator Jerome Haley

COMPLAINT CONTROL NUMBER: 22-AS-20240215092244

FACILITY NAME:	HARBOR HEIGHTS ASSISTED LIVING & MEMORY CARE		FACILITY NUMBER:	306005678
ADMINISTRATOR:	CHRISTINE CHON		FACILITY TYPE:	740
ADDRESS:	525 W. LA PALMA AVE		TELEPHONE:	(714) 459-3353
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	199	CENSUS: 171	DATE:	02/22/2024
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Christen Cho - Administrator		TIME COMPLETED:	03:59 PM

ALLEGATION(S):

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Facility is not kept free of pests.
Residents are not provided clean linens.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jerome Haley made unannounced visit to investigate the complaint received February 15, 2024. LPA Haley was greeted by staff and explained the reason for the visit.

During the visit, LPA Haley toured the kitchen area, laundry area, memory care and assisted living units and interviews were conducted with residents, and staff. A total of 12 interviews were conducted and 3 interviews were attempted. Documents were reviewed, observations were made, and photos were taken.

Regarding the allegation: Facility is not kept free of pests.

12 of 12 individuals interviewed denied the complaint allegation and/or could not provide any evidence to support the allegation. During an interview with Staff 8 (S8), Eco lab comes out and makes monthly inspections and will come out as needed upon request. S8 denied the presence of any bugs, and says in the summertime ants show up and sewage water bugs come through the drains.
Continued on LIC9099C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024

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-20240215092244

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: 02/22/2024

NARRATIVE

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S8 says, Eco lab will come out upon request and will spray the facility and bleach the main drain to resolve the water bug issue, and if ants show up, Eco lab will treat the ant issue with a gel like substance that’ placed on the window seals. During an interview with the Administrator, it was discovered the facility had a case of bed bugs in a resident room in April of 2023. Eco lab came out and treated the room where bed bugs were observed, and the issue was resolved. According to the Administrator, no other bugs have been observed other than maybe some mosquitoes in the courtyard area.

Regarding the allegation: Residents are not provided clean linens.

12 of 12 individuals interviewed denied the complaint allegation and/or could not provide any evidence to support the allegation. According to Staff 2 (S2) the linens are cleaned weekly, and blankets are cleaned every other week, but if the residents request to have their linens or blankets washed, the linens will be washed. During the visit, S2 was doing laundry and provided a copy of the laundry schedule that is followed. Two residents from the assisted living portion of the facility were interviewed and both of the residents said they have clean sheets and blankets. Resident 2 (R2) said they came and cleaned the room yesterday and they did a very good job.

Based on the information gathered during through interview, observation, and document review, the following allegations: Facility is not kept free of pests, and Residents are not provided clean linens, are deemed Unfounded, meaning the allegations are false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024

LIC9099 (FAS) - (06/04)

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