306006452-6-10-2025-22-AS-LMUZ-DM4MUK-20251003095515

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006452
Report Date: 06/10/2025
Date Signed: 06/10/2025 10:18:53 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
10/14/2024 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 22-AS-20241014143034

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: 180	DATE:	06/10/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	SUSAN LEE		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Resident sustained multiple fractures while in facility care due to lack of supervision.

INVESTIGATION FINDINGS:

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On 06/10/25, Donna Gurriere, Licensing Program Analyst (LPA) contacted the administrator via telephone to deliver final findings regarding a complaint that was received on 10/14/24. LPA Gurriere spoke with Susan Lee, Administrator and explained the purpose of the call.

Resident sustained multiple fractures while in facility care due to lack of supervision.

During the interview process, the administrator, staff and resident were interviewed. In addition, documents were reviewed and obtained to include Employee Roster/Contact List, Resident List, Admission Agreement, Physician’s Orders, Physician’s Report, Service Plan, Medical and Hospital Records, Incident Report and Police Records.

continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20241014143034

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: 06/10/2025

NARRATIVE

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During the investigation process, it was reported that the resident (Resident 1) notified a staff person that he had been injured by a resident (Resident 2). It was reported that resident 2 suffered from dementia, had never had aggression issues in the past; however, struck resident 1 with a cane several times. It was stated that staff were present in the building; however, were unaware that resident 2 had aggressed on resident 1. The staff immediately assessed the injury, called for emergency services for resident 1 and contacted the police. It was reported that resident 1 suffered numerous lacerations and fractures.

There is not enough information to support the allegation of resident 1 sustaining severe injuries while in facility care due to lack of supervision. The occurrence was an isolated incident, and no one had suspected that resident 2 would aggress on resident 1. Therefore, in this matter the allegation is unsubstantiated.

Although the above allegation mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the above findings are Unsubstantiated.

Licensee or administrator was advised a copy of this report will be sent via certified mail. Two copies of the report will be sent. Licensee or administrator is to sign and return a copy to the Orange County Regional Office.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025

LIC9099 (FAS) - (06/04)

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