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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006452
Report Date: 10/28/2024
Date Signed: 10/28/2024 09:44:29 AM

Document Has Been Signed on 10/28/2024 09:44 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:HARBOR HEIGHTS ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
306006452
ADMINISTRATOR/
DIRECTOR:		DUSUN LEEFACILITY TYPE:
740
ADDRESS:525 W. LA PALMA AVETELEPHONE:
(714) 459-3353
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 199CENSUS: 194DATE:
10/28/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:22 AM
MET WITH:Susan Lee - Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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On 10/28/2024, LPA Mason made an unannounced visit to the facility for the purpose of conducting a plan of corrections follow-up.

LPA arrived and was greeted and granted entry by Executive Driector Susan Lee. On 10/15/2024 LPA Mason issued deficiencies pertaining to the following Title 22 Regulation:

87555 General Food Service Requirements (20) Food preparation equipment shall be placed to provide aisles of sufficient width to permit easy movement of personnel, mobile equipment and supplies.

and

87555 General Food Service Requirements (21) Freezers of adequate size shall be maintained at a temperature of 0 degrees F (-17.7 degrees C), and refrigerators of adequate size shall maintain a maximum temperature of 40 degrees F (4 degrees C).

LPA toured the kitchen and made the following observations: LPA observed the two-burner stove to be removed from the kitchen and replaced with a one-burner stove that does not extend into the walkway. LPA observed the refrigerator temperature to be set to 40 degrees F and the freezer temperature to
be set to -10 degrees F.

LPA also answered questions from ED regarding resident room assignments and reporting requirements.

Based on today's inspection, LPA determined the facility fulfilled their plans of correction. An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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