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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006452
Report Date: 10/28/2025
Date Signed: 11/19/2025 09:16:14 AM

Unfounded


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
10/22/2025 and conducted by Evaluator Samer Haddadin
COMPLAINT CONTROL NUMBER: 22-AS-20251022115344
FACILITY NAME:HARBOR HEIGHTS ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
306006452
ADMINISTRATOR:DUSUN LEEFACILITY TYPE:
740
ADDRESS:525 W. LA PALMA AVETELEPHONE:
(714) 459-3353
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:199CENSUS: DATE:
10/28/2025
UNANNOUNCEDTIME BEGAN:
01:03 PM
MET WITH:Sammy LeeTIME COMPLETED:
04:29 PM
ALLEGATION(S):
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Staff does not provide food of nutritional quality
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Samer Haddadin conducted an announced visit to the facility to deliver findings regarding the investigated allegation: “Staff does not provide food of nutritional quality.” Upon arrival, LPA met with Assistant Director (AD) Sammy Lee and explained the purpose of the visit.
The investigation included direct observation, interviews with four staff members and four residents, and a review of relevant facility records. All four staff members interviewed denied the allegation. Similarly, all four residents interviewed also denied the allegation.
LPA conducted a walkthrough of the kitchen and observed the area to be clean, organized, and free of mold or mildew. LPA reviewed two food menus: one American and one Korean. Both menus are available for all residents to choose from. During the visit, LPA observed residents having lunch, which included an egg sandwich served with chips and assorted fresh fruits such as grapes, watermelon, and mango.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
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-20251022115344
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: 10/28/2025
NARRATIVE
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LPA also reviewed the Food Handler Certification for the staff responsible for meal preparation and confirmed the certification is current, with an expiration date of June 5, 2026.
Based on the information gathered through interviews, observations, and document review, the allegation “Staff does not provide food of nutritional quality” is unfounded, meaning the allegation is false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was provided to the Assistant Director.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2