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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006452
Report Date: 04/10/2026
Date Signed: 04/10/2026 04:13:45 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
02/26/2025 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250226095550
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: 193DATE:
04/10/2026
UNANNOUNCEDTIME BEGAN:
01:27 PM
MET WITH:David Kim-Director of OperationsTIME COMPLETED:
04:28 PM
ALLEGATION(S):
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Staff do not ensure that resident's incontinence needs are met
Staff do not observe resident for change in condition
Staff do not ensure that facility is maintained in sanitary condition
Staff did not report incidents to responsible party
Staff do not provide resident with toiletries
Staff do not ensure that the facility is maintained in good repair
Staff do not ensure that resident's personal care needs are met
Staff do not provide resident with housekeeping services
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegations received on February 26, 2025. LPA was greeted and granted entry into the facility and met with Director of Operations David Kim. LPA explained the reason for the visit.

This Department has investigated the complaint alleging that staff do not ensure that resident's incontinence needs are met. Regarding the allegation the following was revealed: During the investigation LPA reviewed the Preplacement Appraisal Information dated January 18, 2024, for Resident 1 (R1). Per Preplacement Appraisal Information, R1 needs assistance with toileting. During the course of the interviews with staff, Staff 1 (S1) reported that the resident’s diapers get changed every two hours or as needed. Per S2, R1’s diaper gets changed in the morning and stated that R1 only uses a diaper in case of an emergency. S2 reported that R1 uses the toilet during the day. Per S3, staff ensure that R1’s incontinence needs are met.

CONTINUED ON LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026
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 6
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
02/26/2025 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250226095550

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: 193DATE:
04/10/2026
UNANNOUNCEDTIME BEGAN:
01:27 PM
MET WITH:David Kim-Director of OperationsTIME COMPLETED:
04:28 PM
ALLEGATION(S):
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Staff did not supervise resident, resulting in resident eloping from facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegation received on February 26, 2025. LPA was greeted and granted entry into the facility and met with Director of Operations David Kim. LPA explained the reason for the visit.

This Department has investigated the complaint alleging that staff did not supervise resident, resulting in resident eloping from facility. Regarding the allegation the following was revealed: During the investigation LPA reviewed documents including the Unusual Incident/Injury Report (UIIR) dated February 11, 2025 for Resident 1 (R1). Per UIIR, on January 21 2025, staff checked the CCTC/cameras and reported that the footage indicated that R1 had eloped from the facility. Per UIIR, at 10:50 a.m. a helicopter located R1 and brought her back to the facility. During the interviews the AD reported that R1 exited the facility through the broken Memory Care entrance by the main entrance.

CONTINUED ON LIC9099A-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 22-AS-20250226095550
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: 04/10/2026
NARRATIVE
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Based on the evidence gathered, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. The facility is cited per Title 22, Division 6 of the California Code of Regulations.

An exit interview was conducted and a copy of this report, LIC9099-D, and Appeal Rights were provided.
An exit interview was conducted with Director of Operations Kim, and a copy of this report was left at the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 22-AS-20250226095550
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/10/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/13/2026
Section Cited
CCR
87411(a)
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87411 Personnel Requirements - General (a)Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of
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Licensee to read regulation and write a statement of understanding. Licensee to submit a Plan of Correction on how to prevent future elopements. Licensee to email LPA POC by due date.
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personal assistance and care...
This requirement is not met as evidence by: Per Unusual Incident/Injury Report (UIIR) dated 2/11/25, on 1/21/25 at 10:30 AM R1 left the facility unassisted. Per Physician Report (LIC602A) R1 is not Able to Leave Facility Unassisted.
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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.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 22-AS-20250226095550
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: 04/10/2026
NARRATIVE
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Regarding the allegation that staff do not observe resident for change in condition, the following was revealed: During the interviews, S1 reported that the changes get reported to the Medication Technician (MT). S1 stated that she did not notice a change in condition for R1. S2 stated that R1 has not had a change in condition since she moved in. Per S3, R1 sees her Primary Care Physician (PCP) regularly and reported that R1’s PCP recently referred her to a neurologist. During the interviews AD reported that staff keep track of the residents’ change in condition by updating the progress notes and by seeing their PCP.

Regarding the allegation that staff do not ensure that facility is maintained in sanitary condition, the following was revealed: During the initial visit on February 28, 2025, and subsequent visit on April 10, 2026, LPA tour the facility and observed housekeeping staff cleaning the common areas and the residents’ bedrooms. During the interviews with staff, S1 through S3 reported that staff are always cleaning and/or stated that the facility is sanitized daily by housekeeping. Per Environmental Services Director, the resident bedrooms get deep cleaned every week and reported that housekeeping cleans and sanitize the facility daily.

Regarding the allegation that staff did not report incidents to responsible party, the following was revealed: During the investigation LPA was not able to get in contact and/or interview Witness 1 (W1). During the interviews with staff, S1 and S2 reported that they were not aware if the incident report was reported to R1’s family. Per S3, staff do report incidents to the Responsible Party and stated that the Administrator (AD) notify R1’s family.

Regarding the allegation that staff do not provide resident with toiletries, the following was revealed: During the interviews with staff, S1 reported that the residents are provided with toilet paper and diapers. S1 stated that there is more supplies in the storage room. Per S2, R1 tends to pull and rip her own diapers. S3 stated that R1 has enough diapers and reported that R1 usually throws away her clean diapers inside the toilet. During the interviews AD stated that staff provide the residents with enough incontinence care supplies.

Regarding the allegation that staff do not ensure that the facility is maintained in good repair, the following was revealed: During the initial and subsequent visit LPA tour the facility and observed the facility to be in good repair. During the interviews with staff, S1 reported that the maintenance staff is always working on repairs. Per S2 and S3, the facility is in good repair and stated that the delayed egress door was fixed the same day. During the interviews AD reported that the facility is always maintained in good repair.

CONTINUED ON LIC9099-C...

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 22-AS-20250226095550
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: 04/10/2026
NARRATIVE
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Regarding the allegation that staff do not ensure that resident's personal care needs are met, the following was revealed: During the investigation LPA reviewed the Harbor Heights Assisted Living and Memory Care shower schedule for R1. Per shower schedule, R1 is schedule to shower on Sunday and Wednesday mornings. LPA also reviewed the Harbor Heights Assisted Living and Memory Care housekeeping laundry schedule for R1. Per laundry schedule, R1’s laundry day is on Tuesdays. During the interviews with staff, S1 through S3 reported that staff ensure that the residents’ personal care needs are met. Per Environmental Services Director, staff are meeting the residents needs.

Regarding the allegation that staff do not provide resident with housekeeping services, the following was revealed: During the investigation LPA reviewed the Harbor Heights Assisted Living and Memory Care housekeeping cleaning schedule. Per housekeeping cleaning schedule, staff clean R1’s bedroom on Thursdays. During the interviews with staff, S1 through S3 reported that staff clean the bedrooms weekly or as needed. Per Environmental Services Director, staff clean the Memory Care restrooms daily, take out the trash daily, and wash the bedding weekly or as needed.

Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegations occurred as reported due to conflicting information. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed UNSUBSTANTIATED.

For today’s visit, there were no citations issued per Title 22, Division 6 of the California Code of Regulations.

LPA conducted an exit interview with Director of Operations Kim, and a copy of this report was provided to the facility.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6