Community Care Licensing

Document Has Been Signed on 10/15/2024 10:14 AM - It Cannot Be Edited

FACILITY NAME:	HARBOR HEIGHTS ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	306006452
ADMINISTRATOR/ DIRECTOR:	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: 194	DATE:	10/15/2024
TYPE OF VISIT:	POC	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:34 AM
MET WITH:	Susan Lee - Executive Director		TIME VISIT/ INSPECTION COMPLETED:	10:30 AM

SUPERVISORS NAME: Armando J Lucero LICENSING EVALUATOR NAME: Dwayne L Mason LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024

Link to Parent Document Below:

FACILITY NAME: HARBOR HEIGHTS ASSISTED LIVING AND MEMORY CARE	FACILITY NUMBER: 306006452
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/15/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/23/2024 Section Cited CCR 87555(b)(21)	1 2 3 4 5 6 7	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). They shall be kept clean and food stored to	1 2 3 4 5 6 7	Executive Director stated they will create a log to document the refrigerator temperatures. ED also stated they will continue trying to work with maintenance to get the refrigerator temperature below 40 degrees F. LPA will verify the plan of correction via plan of corrections visit.
	8 9 10 11 12 13 14	enable adequate air circulation to maintain the above temperatures. Based on observations, the Licensee did not comply with the regulation cited above due to the refrigerator temperature being set between 42-43 degrees F. This creates a potential health risk to persons in care.	8 9 10 11 12 13 14
Type B 10/23/2024 Section Cited CCR87555(b)(20)	1 2 3 4 5 6 7	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. Based on observations, the Licensee did not	1 2 3 4 5 6 7	Executive Director stated they will replace the two-burner stove in the facility with a single-burner stove by the assigned POC due date. LPA will verify the correction at a plan of corrections visit.
	8 9 10 11 12 13 14	comply with the section cited above due to a 2-burner stove in the kitchen protruding 17.5 inches into the aisle where kitchen staff work and move.	8 9 10 11 12 13 14

SUPERVISOR'S NAME: Armando J Lucero LICENSING EVALUATOR NAME: Dwayne L Mason LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024