<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 03/19/2021
Date Signed: 03/19/2021 03:40:43 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
08/11/2020 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20200811091658
FACILITY NAME:HARBOR HEIGHTS ASSISTED LIVING & MEMORY CAREFACILITY NUMBER:
306005678
ADMINISTRATOR:AHAOMA S. ONYEBUCHIFACILITY TYPE:
740
ADDRESS:525 W. LA PALMA AVETELEPHONE:
(714) 860-4016
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:199CENSUS: 47DATE:
03/19/2021
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Paul BrownTIME COMPLETED:
02:33 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident's wheelchair is in disrepair.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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; resident's (R1) wheelchair is in disrepair, the investigation revealed the following. R1's wheelchair broke because of it's age and normal use. Administrator was notified about the wheelchair and provided R1 with a working wheelchair and contacted the company that provided R1 with his wheelchair. Staff and R1 verified this. Staff and R1 both reported that the company could repair the wheelchair but it would be an out of pocket expense since the repair would not be covered by warranty or insurance. R1 and the facility both declined to pay for the wheelchair to be fixed. The facility assisted R1 in attempting to fix the wheelchair and provided R1 with a working wheelchair. The facility is not required to pay for R1's wheelchair repair. 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.
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: 03/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2021
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-20200811091658
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: 03/19/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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 AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2