306006452-6-1-2026-22-AS-AORZ-DWFPRT-20260729113312

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006452
Report Date: 05/31/2026
Date Signed: 06/01/2026 11:08:12 AM

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
08/14/2024 and conducted by Evaluator Samer Haddadin

COMPLAINT CONTROL NUMBER: 22-AS-20240814155709

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: 196	DATE:	05/31/2026
		UNANNOUNCED	TIME BEGAN:	10:11 AM
MET WITH:	Susan Lee		TIME COMPLETED:	01:19 PM

ALLEGATION(S):

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1-Staff do not ensure residents was adequately hydrated
2-Staff do not assist residents self-administer their medication

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility to deliver findings regarding the above-mentioned allegations. Upon arrival, LPA Haddadin was greeted by Case Manager, April Pena who granted entry into the facility. LPA explained the purpose of the visit. Administrator Susan Lee arrived shortly thereafter.
The Department received a complaint alleging that “Staff do not assist residents self-administer their medication” and “Staff do not ensure residents were adequately hydrated.”
During the investigation, LPA interviewed six residents and six staff members, reviewed pertinent facility records, and observed the physical plant and residents in care. Records reviewed included the LIC 602 Physician’s Report, facility, admission records, physician Orders and medication records for Resident 1 (R1) and Resident 2 (R2). {***CONTINUE 9099C***)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2026

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 3

Control Number 22-AS-20240814155709

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: 05/31/2026

NARRATIVE

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LPA attempted to identify the residents referenced in the complaint using room numbers, physical descriptions, and available facility records. Facility admission records showed that R1 was admitted to the facility on April 1, 2024, and R2 was admitted to the facility on February 23, 2024. At the time of the investigation, R1 and R2, who were identified as the alleged victim residents, no longer resided at the facility and had moved out.
Regarding the allegation that “Staff do not assist residents self-administer their medication,” the complaint alleged that two residents had mixed up paper cups containing medication and were unsure which medication to take. During the investigation, LPA reviewed the LIC 602 Physician’s Reports, facility progress notes, admission records, and medication records for Resident 1 (R1) and Resident 2 (R2) from February 2024 through August 2024. The records reviewed did not show documented medication errors, missed medication doses, or concerns related to medication assistance. The records reflected that medications were documented as provided by MedTech staff. LPA also interviewed six residents and six staff members regarding medication assistance and facility medication procedures. Staff interviewed denied leaving medication unattended with residents and denied knowledge of the alleged incident. Six out of six staff members interviewed did not provide statements corroborating that residents were left with medication cups, that medications were mixed up, or that residents did not receive medication assistance as required. Six out of six residents interviewed did not report concerns regarding medication assistance or staff failing to assist residents with self-administered medications. During the walkthrough, LPA observed medication being dispensed by a MedTech. LPA observed the MedTech verify the resident’s name against the name on the medication, confirm the resident’s room number, and compare the resident’s photograph with the resident being assisted. LPA further observed the MedTech provide the medication to the resident and remain with the resident until the medication was safely taken before proceeding to the next resident.
Regarding the allegation that “Staff do not ensure residents were adequately hydrated,” the complaint alleged that a resident was hospitalized and was reportedly informed by hospital personnel that the resident was severely dehydrated.
{***CONTINUE 9099C***)

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 22-AS-20240814155709

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: 05/31/2026

NARRATIVE

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During the investigation, LPA reviewed facility progress notes and admission records and interviewed staff regarding the facility offering fluids. R2 was no longer residing at the facility at the time of the investigation and had moved out. LPA reviewed R2’s file and R1’s file and the records reviewed did not show ongoing concerns regarding residents not being provided with water or fluids nor hospitalized due to dehydrations. LPA also conducted a digital record review with the Community Care Licensing Division and did not locate any Special Incident Reports (SIR) submitted by the facility for the period of February 2024 through December 2024 related to the allegation. All six staff interviewed denied the allegation. Six out of six residents interviewed denied the allegation and did not report concerns regarding access to water or fluids.
Based on interviews conducted, records reviewed, and observations made during the investigation, the Department did not obtain sufficient evidence to support the allegations. Although the allegations may have happened or may be valid, the preponderance of evidence standard was not met. Therefore, the allegations are Unsubstantiated.
An exit interview was conducted with Administrator Susan Lee, and a copy of this report was provided.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2026

LIC9099 (FAS) - (06/04)

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