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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006372
Report Date: 08/28/2024
Date Signed: 08/28/2024 03:31:31 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
08/21/2024 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20240821154034
FACILITY NAME:HIGHTOWER RESIDENTIAL CAREFACILITY NUMBER:
306006372
ADMINISTRATOR:ARONNE, CELFAFACILITY TYPE:
740
ADDRESS:23391 CAVANAUGH ROADTELEPHONE:
(949) 500-3760
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:6CENSUS: 3DATE:
08/28/2024
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Norma AronneTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility did not provide refund
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Kimberly Lyman and Sam Haddadin conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPAs were greeted and granted entry into the facility and explained the reason for the visit.
During the investigation, LPAs toured the facility and interviewed Administrator. Regarding the allegation that facility did not provide refund, the investigation revealed the following: Resident 1 (R1) admitted into the facility on 08/12/2024 around 6 PM. R1 passed away later that evening around 12:00 AM. Resident's belongings were removed on or about 08/13/2024. Resident's responsible party paid a pre-admission fee of $1500 and pre-payment of rent in the amount of $9000. Department regulation require a refund of 80 percent of pre-admission fee when resident leaves the facility within 30 days of admittance. Additionally, pre-paid rents are due to the resident/ family for the remaining balance once resident's items are removed from the facility. The refund amount includes $1200 for the pre-admission fee and $8130 for pre-paid rent resulting in a total of $9330. Resident's responsible party has not received a refund to date. Based on interviews conducted, the preponderance of evidence standard has been met. CONTINUED ON LIC 9099C DATED 08/28/2024.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
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 3
Control Number 22-AS-20240821154034
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: HIGHTOWER RESIDENTIAL CARE
FACILITY NUMBER: 306006372
VISIT DATE: 08/28/2024
NARRATIVE
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Therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report was provided to facility administrator along with appeal rights.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 22-AS-20240821154034
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: HIGHTOWER RESIDENTIAL CARE
FACILITY NUMBER: 306006372
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/04/2024
Section Cited
HSC
1569.652(c)
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A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual.. to the resident’s estate, within 15 days after the personal property is removed. This req is not being met as evidenced by:
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Licensee to refund $9330 to resident's responsible party and forward proof to LPA by POC due date.
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Based on interviews conducted, the licensee failed to ensure a refund was provided to resident/ responsible party. This poses a potential health and safety risk 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: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3