306006452-9-5-2025-22-AS-APAO-DLN6NY-20250918205817

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006452
Report Date: 09/04/2025
Date Signed: 09/05/2025 12:56:14 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
08/20/2025 and conducted by Evaluator Samer Haddadin

COMPLAINT CONTROL NUMBER: 22-AS-20250820103207

FACILITY NAME:	HARBOR HEIGHTS ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	306006452
ADMINISTRATOR:	DUSUN LEE		FACILITY TYPE:	740
ADDRESS:	525 W. LA PALMA AVE		TELEPHONE:	(714) 459-3353
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	199	CENSUS:	DATE:	09/04/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Susan Lee		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Resident sustained an injury due to lack of supervision
Staff do not ensure facility is clean and orderly
Staff do not ensure facility is odorless

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced complaint visit to the facility to deliver findings regarding the above allegations. Upon arrival, LPA Haddadin met with Administrator, Susan Lee, and advised her of the purpose of the visit. During the course of the investigation, LPA Haddadin conducted five (5) staff interviews and five (5) resident interviews. All staff and residents interviewed denied the following allegations: “Resident sustained an injury due to lack of supervision,” “Staff do not ensure facility is clean and orderly,” and “Staff do not ensure facility is odorless.” LPA Haddadin also reviewed facility records, staff records, and resident records. It was alleged that a resident sustained an injury due to lack of supervision. Record review revealed that Resident 1 (R1) had sustained a bruise to the left eye. {***CONT*** 9099C}

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

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-20250820103207

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: HARBOR HEIGHTS ASSISTED LIVING AND MEMORY CARE	FACILITY NUMBER: 306006452
	VISIT DATE: 09/04/2025

NARRATIVE

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The incident occurred in the Memory Care Unit when R1 mistakenly entered another resident’s room, believing it was their own. The other resident struck R1, which resulted in the bruise. Documentation showed that facility staff immediately applied first aid and offered to transport R1 to urgent care, which R1 declined. Facility records indicate that R1’s primary physician was notified of the incident. Furthermore, staff relocated the other resident involved to a different apartment unit to prevent future incidents. Review of R1’s physician report states that R1 was able to communicate their needs and reported no pain when assessed.
As to the allegations that staff do not ensure the facility is clean, orderly, and odor-free, LPA Haddadin conducted a facility walk-through, inspecting resident rooms, common areas, and restrooms. LPA did not observe any evidence supporting the allegations. Resident interviews confirmed that the facility did not have issues with cleanliness or odors of incontinence. LPA observed that each resident’s door displayed a housekeeping schedule indicating that rooms are cleaned twice a week, as well as upon request. Facility records included both a Janitorial Cleaning Schedule, which documents cleaning of common areas, and a Housekeeping Cleaning Schedule, which tracks resident rooms cleaned on assigned service days. Both record review and direct observations corroborated that cleaning protocols are in place and followed. Five of five staff interviews and five of five resident interviews denied the allegations.
Based on the information obtained, the Department could not corroborate the allegations. While the allegations may have occurred or could be valid, there is not a preponderance of evidence to prove or disprove that the violations took place. Therefore, the allegations are determined to be Unsubstantiated.
An exit interview was conducted, and a copy of this report was provided to the facility representative.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

LIC9099 (FAS) - (06/04)

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