306006452-8-22-2025-22-AS-APAO-DL22UD-20250829174211

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006452
Report Date: 08/20/2025
Date Signed: 08/22/2025 04:55:52 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
05/28/2025 and conducted by Evaluator Samer Haddadin

COMPLAINT CONTROL NUMBER: 22-AS-20250528081707

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: 194	DATE:	08/20/2025
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Sammy Lee		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff handled residents in care in a rough manner resulting in injuries
Staff refused to seek medical attention for resident in care
Staff did not shower residents in care resulting in rashes

INVESTIGATION FINDINGS:

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On August 20, 2025, Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility to deliver findings for the above allegations. LPA Haddadin met with Assistant Executive Director Sammy Lee, explained the purpose of the visit, and was granted entry into the facility.
The investigation into the allegation that “Staff did not shower residents in care resulting in rashes” revealed the following: LPA Haddadin conducted interviews with six staff members and six residents. All individuals interviewed denied that residents missed scheduled showers or developed rashes as a result of poor hygiene and or incontinence. A review of facility documentation indicated that residents requiring assistance are placed on a regular twice-weekly shower schedule.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025

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-20250528081707

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: 08/20/2025

NARRATIVE

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LPA Haddadin also reviewed Shower–Body Check Forms for nine randomly selected residents across various dates. These forms were properly completed and documented that full body checks were performed at the time of showering to ensure no injuries, bruises, or rashes were present. In addition, LPA Haddadin interviewed residents in their rooms and did not observe any residents with rashes or signs of neglect; no odors suggestive of poor hygiene were detected.
The investigation into the allegation that “Staff refused to seek medical attention for resident in care” revealed the following: interviews with six staff members and six residents did not identify any instances in which medical attention was delayed or refused. A review of records for Resident-1 (R1) indicated that the resident was actively receiving hospice care and home health services for a pressure injury, which was managed by a wound specialist on weekly onsite visits. Medical records further documented that R1’s primary physician conducted a follow-up onsite visit on June 26, 2025, which stated: “no suspicious lesions, no suspicious bruises and no evidence of scars, with normal skin coloration and moisture.”
The investigation into the allegation that “Staff handled residents in care in a rough manner resulting in injuries” revealed the following: All six staff members and six residents interviewed denied that staff handled residents roughly or caused injuries. A review of facility records confirmed that the facility has policies in place requiring staff to maintain training consistent with their duties. This policy is outlined in the facility’s Policy and Procedures, pages 7 and 8. Staff files documented participation in training sessions, including one held on April 23, 2025, and a refresher session on June 10, 2025. Staff files also contained signed SOC 341 (Mandated Reporter) forms, demonstrating staff awareness of their reporting responsibilities of any type of abuse or neglect towards any residence.
Based on the information obtained, the Department could not corroborate the allegations. While the allegations may have occurred or could be valid, there is not a preponderance of the evidence to prove or disprove that the violations took place. Therefore, the allegations are determined to be Unsubstantiated.
An exit interview was conducted, and a copy of this report was discussed with and provided to facility representative.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025

LIC9099 (FAS) - (06/04)

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