Harbor Heights Assisted Living and Memory Care.

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced case management visit at the facility regarding a Special Incident Report received by the Department on May 14, 2026. The report stated that Resident 1 (R1) was found on the floor due to an unwitnessed fall. Upon arrival, LPA met with Susan Lee, Administrator, who greeted LPA and granted entry into the facility. The purpose of today’s visit was explained. During the visit, LPA reviewed R1’s Physician’s Report and discussed R1’s current condition with Administrator Lee. Administrator Lee stated that R1 remains hospitalized at this time. The facility contacted the hospital for an update regarding R1’s condition and was informed by hospital staff that no fractures were identified. LPA reviewed relevant facility records related to R1 and discussed the incident with facility staff. At the time of the visit, LPA did not observe any immediate health and safety concerns. No deficiencies were cited during today’s visit. An exit interview was conducted, and a copy of this report was provided to the facility.

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to complete the facility’s required annual inspection. Upon arrival, LPA met with Executive Director (ED) Susan Lee and explained the purpose of the visit. The facility is licensed for a capacity of 199 residents and is approved for 199 non-ambulatory residents, of which five may be bedridden. The facility also has an approved hospice waiver for 25 residents. The facility telephone number is (714) 459-3353. At the time of the visit, there were 192 residents in care. LPA toured the interior and exterior areas of the facility with staff and observed the following: The facility is a three-story building with an interior courtyard containing a fountain and an attached parking garage. The facility has 115 resident rooms, and each room has its own bathroom. There is also an outdoor patio at the rear of the building for resident use. Both the back patio and the interior courtyard have shaded areas available for residents. The building has five stairwells, and LPA observed that each stairwell was equipped with an emergency evacuation chair. LPA also observed the PUB 475 poster posted in the entryway of the facility and in the staff break room. A sitting room with books and seating was observed near the main entrance.LPA inspected the memory care unit and checked the hot water temperature in six resident rooms, which measured between 110.9 and 112.8 degrees Fahrenheit. In the assisted living building, LPA checked the hot water temperature in six resident rooms and observed readings between 113.9 and 119.2 degrees Fahrenheit. {***CONTINUE 809C***} 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA observed that the kitchen was clean and operational. The facility had the required two-day supply of perishable food and seven-day supply of nonperishable food on hand. LPA observed that all chemicals and sharps were locked and inaccessible to residents in care. Resident rooms contained clean linens, appropriate furniture, chairs, and hygiene supplies. Fire extinguishers were observed to be fully charged, with indicators in the green zone, and had a service date of March 5, 2026. The fire alarm system and smoke detectors are inspected by a third-party company, Evron, with the most recent inspection completed on March 5, 2026. LPA inspected the medication room and observed that all medications were locked and inaccessible to residents in care. Medications are administered by med-tech staff. The first aid kit and first aid manual were stored in the first-floor medication room and in the memory care unit. All first aid kits were observed to contain the required supplies. LPA reviewed 12 resident files and medications and observed no discrepancies. LPA also reviewed 12 electronic staff files and found that all required paperwork was current and complete. Facility records showed that the most recent emergency drill was conducted on March 20, 2026. Based on observations made during today’s inspection, NO deficiencies are being cited pursuant to Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and a copy of this report was provided to ED Susan Lee at the conclusion of the inspection.

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced case management visit to the facility. Upon arrival, LPA Haddadin was granted entry and met with Administrator (AD) Susan Lee, to whom the purpose of the visit was explained. On March 27, 2026, the office received an incident report from the facility stating that Resident 1 (R1) had been transported to the hospital following an unwitnessed fall. The report did not include any further information regarding R1’s condition or status. During the visit, LPA reviewed the facility’s records and the hospital discharge paperwork. Based on the information obtained, no deficiencies were cited. An exit interview was conducted, and a copy of this report was provided to the facility.

LPA conducted a phone interview with R1’s RP, who stated that R1 is ambulatory, physically active, and that the facility had been caring for R1 appropriately with no prior concerns. LPA also reviewed records and observed that the Physician’s Report, dated 08/05/2025, documented that R1 was ambulatory, able to follow instructions, able to communicate needs, able to leave the facility unassisted, and able to bathe independently. The report further reflected that R1’s overall health status was assessed as fair. Based on interviews conducted and records reviewed, there was insufficient evidence to support that the alleged violation occurred. Although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove or disprove that a violation took place. Therefore, the allegation is deemed unsubstantiated. An exit interview was conducted with the Administrator Assistant, and a copy of this report was provided to the facility representative.

Regarding the allegations, “Staff left residents in soiled diapers too long, causing a rash,” “Staff did not clean resident rooms,” and “Staff did not provide proper medication assistance,” LPA interviewed four staff members and four residents, all of whom denied the allegations. During the facility walk-through, LPA did not detect any incontinence odor from the residents interviewed. LPA also reviewed the facility’s Shower Body Check Forms, which showed that residents requiring bathing assistance were scheduled to bathe twice per week. These forms also required caregivers to document any rashes or bruising observed on residents. None of the forms reviewed contained documentation of any rashes. LPA interviewed four staff members who stated that the facility employs both housekeeping and maintenance staff to clean resident rooms and common areas. Staff reported that housekeeping personnel clean resident rooms, bathrooms, and common areas daily, with additional cleaning completed as needed. LPA also interviewed four residents, all of whom stated that their rooms are cleaned regularly and that they had not observed any unclean rooms. In addition, LPA reviewed three random Medication Administration Records (MARs) for selected residents. The records reflected accurate and timely medication administration. LPA also observed the facility’s medication administration process during the visit. During this observation, LPA noted that Medication Technicians verified each medication against the resident’s name, dosage, and photograph before dispensing. Regarding the allegation, “Staff are not properly trained,” LPA reviewed staff records and training documentation maintained by the facility. The records showed that staff had completed the required training relevant to their assigned duties. For example, all Medication Technicians had completed the required annual eight-hour training, and caregiver staff had completed mandatory training provided by the facility. LPA also interviewed four staff members, who stated that they had received training from the facility and understood their responsibilities related to resident care and supervision. LPA further interviewed four residents, none of whom reported concerns indicating that staff were untrained or unable to perform their duties. Regarding the allegation, “Staff failed to properly supervise residents, resulting in falls,” LPA reviewed four random residents' incident reports related to falls. The records reviewed did not reveal evidence to show that falls occurred as a result of staff neglect or lack of supervision. {***CONTINUE9099C***) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA interviewed four staff members, who stated that residents are monitored and assisted based on their individual care needs and that falls are documented and addressed when they occur. LPA also interviewed four residents, none of whom provided information supporting the allegation that staff failed to properly supervise residents, resulting in falls. Based on the investigation, there was insufficient evidence to prove that the alleged violations occurred. Therefore, the allegations are deemed unsubstantiated. An exit interview was conducted, and a copy of this report was provided to Case Manager (CM) April Pena.

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced Plan of Correction (POC) follow-up visit to Harbor Heights to verify correction of a prior deficiency cited on August 20, 2025. Upon arrival, LPA Haddadin was granted entry and met with Administrator Susan Lee Based on observation and record review, the facility demonstrated that the corrective action was implemented and sustained. The deficiency cited on August 20, 2025, is cleared as of the date of this visit. An exit interview was conducted and a copy of this report was provided to Med-Tec Supervisor as AD was in a meeting.

The facility maintains two distinct menus to accommodate resident preferences: an American menu and a Korean menu. Both menus are available to all residents. During the visit, LPA Haddadin observed the breakfast service, which included egg sandwiches, bread with jam, sweet potatoes for the Korean menu, and potato oatmeal for the American menu. These items were found to be in strict accordance with the facility’s posted meal plans. Furthermore, the lunch preparation was observed to include croissants, tuna or chicken sandwiches, a side of fresh vegetables, and a choice of apples or strawberries. Additionally, a review of the Food Handler Certification for the staff responsible for meal preparation was conducted. The certification was confirmed to be current and valid, with an expiration date of June 5, 2026. Based on the evidence gathered through interviews, direct observations, and document reviews, the allegation that “Facility staff do not provide quality meals to residents” is determined to be unfounded. This indicates that the allegation is false, could not have occurred, or is otherwise without a reasonable basis. An exit interview was conducted at the conclusion of the visit, and a formal copy of this report was provided to Case Manager April Pena.

Licensing Program Analyst (LPA) Samer Haddadin along with Licensing Program Manager (LPM) Alisa Ortiz, and Assistant Program Administrator (APA) Araceli Ramires had an office meeting with this facility on this day. LPA, LPM and APA met with Administrator (AD) Susan Lee, Assistant Administrator Sammy Lee and Case Manager April Pena . On January 21, 2026, LPA Haddadin called the facility phone number a total of three times with no answer. In order to establish contact, LPA was required to contact Licensees direct wireless telephone number. During today's office meeting, Licensee was advised that this was not an isolated incident of facility not answering facility phone ,and that per LPA's experience receptionist was not present. Licensee was reminded of requirement for facility phone to be answered. During today's meeting, the facility was given a Technical Violation and was advised that it could lead to an actual citation. An exit interview was conducted and a copy of this report along with Technical Violation was provided.

5:26 PM; in the email from the family member, it’s clear the family member was made aware of the incident regarding R1 as the family member was requesting video of the incident that took place the previous day. Based on the information gathered through document review, the allegation is deemed 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.

LPA Haddadin reviewed facility records and confirmed the current administrator holds an active certificate that was renewed on May 14, 2024, and expires on May 13, 2026. Based on the documentation reviewed, the current administrator meets the required qualification requirements. LPA Haddadin also reviewed the LIC 500 (Personnel Report), which is used to maintain a current roster of all facility personnel, and observed the facility maintains adequate staffing to meet resident needs. In addition, LPA Haddadin conducted interviews with four staff members and four residents, all of whom denied the allegations. Regarding the allegations that the facility emergency backup generator is inoperable and that the facility laundry area was constructed without fire clearance, LPA conducted a walk-through of the facility and confirmed the generator was working. LPA did not observe any construction or physical changes to the facility. LPA obtained the current fire clearance approved by the Anaheim Fire Department and confirmed there were no changes and that the current clearance matches the physical plant. LPA conducted four staff interviews, and four out of four denied the allegations. LPA also conducted four resident interviews, and all residents denied the allegations. Therefore, based on the preponderance of evidence obtained through record review, interviews, and observations, the allegations are determined to be UNFOUNDED, meaning the allegations are false, could not have happened, and/or are without a reasonable basis. No deficiencies were cited during today’s visit. An exit interview was conducted with the administrator, and a copy of this report was provided.

Licensing Program Analyst (LPA) Samer Haddadin conducted an announced Plan of Correction (POC) inspection visit. LPA met Case Manager (CM) April Pena, and explained the purpose of the visit. On Friday, January 2, 2025, the facility was cited for a substantiated allegation under Title 22, California Code of Regulations, section 87411(a), Type A. The deficiency posed an immediate health and safety risk to four of four residents who require one-on-one supervision. On Jan 7 th , the deficiency was not corrected and a civil penalty was assessed. As of January 15 th , 2026, the facility again failed to correct the cited deficiency; therefore, civil penalties are being assessed. See LIC 421FC (Failure to Correct). An exit interview was conducted, and a copy of this report and appeal rights were discussed with and provided to CM April Pena.

Licensing Program Analyst (LPA) Samer Haddadin conducted an announced Plan of Correction (POC) inspection visit. LPA met with Sammy Lee, Assistant Administrator, and Case Manager (CM) April Pena, and explained the purpose of the visit. On Friday, January 2, 2025, the facility was cited for a substantiated allegation under Title 22, California Code of Regulations, section 87411(a), Type A. The deficiency posed an immediate health and safety risk to four of four residents who require one-on-one supervision. The facility was provided a POC due date of January 5, 2026, to correct the deficiency. During today’s visit, the facility failed to correct the cited deficiency; therefore, civil penalties are being assessed. See LIC 421FC (Failure to Correct). An exit interview was conducted, and a copy of this report and appeal rights were discussed with and provided to CM April Pena.

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced case management visit to deliver findings on an investigation completed by the Department. . Upon arrival, LPA Haddadin was greeted and granted entry by Case Manager, April Pena, in which the purpose of the visit was explained. On September 29, 2025, the Department received an incident report regarding the death of Resident (R1) following an unwitnessed fall that occurred on September 26, 2025. The investigation determined as follows: R1 was admitted to the facility on January 15, 2024, to the facility Assisted Living and later transferred to the facility’s Memory Care Unit on June 06, 2025, due to increased care needs. Prior to admission, a Physician’s Report dated December 14, 2023, and a Preplacement Appraisal dated January 15, 2024, documented that R1 was ambulatory, able to communicate needs, and able to ambulate using a cane and walker. While in care, R1 experienced multiple falls over time. Per facility documentation, the first reported fall occurred on April 30, 2025, while R1 was still in assisted living. Per incident report, R1 sustained an unwitnessed fall inside their room, was able to get up without assistance, and later complained of wrist pain. R1 initially did not report the fall right away to staff. R1 was transported to the hospital following reports of pain, where they were diagnosed with a wrist fracture. After R1 transitioned to the facility Memory Care on June 06, 2025, additional falls were documented. Facility records reflected a second fall occurred on September 08, 2025; a third fall on September 16, 2025; and a fourth fall on September 26, 2025. During an interview, Staff (S1) stated that, on September 08, 2025, R1 attempted to access the dining room while doors were locked for cleaning.{***CONTINUE 809C***} 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 S1 reported R1 was pulling on the doors while using a walker, lost balance, and fell. Hospital discharge paperwork dated September 08, 2025, documented a facial fracture involving the right maxillary sinus as a result of the fall. Regarding the September 16, 2025, fall, staff reported witnessing R1 fall in the hallway after turning into another resident, resulting in R1 losing balance and falling. R1 was transported to the hospital due to left shoulder pain, and a proximal humerus fracture was identified. On September 26, 2025, R1 experienced an unwitnessed fall in their room. Per incident report, R1 was found on the floor next to the bed. Facility staff contacted 911 and notified R1’s family. R1 reported the fall occurred while attempting to move from the bed to a table, and that the walker was located near the bed. R1 was transported to the hospital and did not return to the facility. Per interviews with staff, R1 generally used a walker but, over time, became less consistent using the walker inside the room and required redirection. Staff (S2) stated the facility had discussed R1’s increasing needs with the family and reviewed possible options, including hospice, a skilled nursing facility, or one-on-one care. S2 also stated the facility obtained a hospital bed so it could be lowered closer to the floor in an effort to reduce risk. S2 reported hospice services were scheduled to begin on October 01, 2025; however, R1 passed away prior to the start of hospice. Hospital records obtained documented that R1’s condition declined while hospitalized, including worsening breathing and decreasing oxygen levels, which led to transfer to the ICU. R1 was later pronounced deceased. A Record of Death documented the date of death as September 29, 2025, and listed cardiopulmonary arrest as the cause of death. Based on the evidence gathered through interviews and record reviews, there is insufficient evidence to support the allegation that R1’s falls were caused due to neglect. Because the preponderance of evidence has not been met, the allegation is determined to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is no preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted, and a copy of this report and confidential names list was provided to the facility's Case Manager: April Pena who signed on this report.

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced case management visit. LPA Haddadin was granted entry into the facility and met with Administrator (AD) Susan Lee, to whom the purpose of the visit was explained. On December 17, 2025, the office received an incident report from the facility stating that Resident (R1) was transported to the hospital due to a spinal fracture related to a previous doctor’s appointment, and that R1 was discharged the same day. During the visit, LPA reviewed the facility’s records and the physician’s report. The physician’s report indicated that R1 had previously attended a doctor’s appointment during which R1 experienced a fall, and the same physician subsequently determined that the injury was a spinal fracture. No deficiencies were cited. An exit interview was conducted, and a copy of this report was provided to the facility .

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced case management visit to the facility for the purpose of delivering an amended report dated 11/12/2025 . Upon arrival, LPA Haddadin was granted entry by Director Susan Lee, and the purpose of the visit was explained. During the visit, LPA reviewed the amended report with the Assistant Director. An exit interview was conducted, and a copy of this case management report, along with the amended report, was provided to the Assistant Director.

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced case management visit to the facility for the purposes of delivering amended report dated 8/12/2025 . Upon arrival, LPA Haddadin was granted entry by AD Susan Lee and explained the purpose of the visit. During the visit, LPA reviewed the amended report with AD. An exit interview was conducted and . a copy of this report and amended report was provided to AD.

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.

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced case management visit and met with Executive Director, Susan Lee The purpose of the visit was to follow up on two incident reports received by Community Care Licensing (CCL) regarding the same resident (R1), who resided in the facility’s memory care unit. The first report, dated September 29, 2025, indicated that R1 complained of shoulder pain and was transported to a nearby hospital for evaluation. The second report, received by CCL on October 3, 2025, was a death report for R1. According to the report, the hospital disclosed the cause of death only to the family and not to the facility. During the visit, LPA toured the interior and exterior of the facility, reviewed R1’s file, and obtained the most recent hospital discharge paperwork along with the physician’s report and care plan. No immediate health or safety concerns were observed during the visit. No deficiencies were cited at this time. An exit interview was conducted, and a copy of this report was provided to the facility.

Licensing Program Analyst (LPA) Sam Haddadin conducted an unannounced case management visit to the facility and was greeted by Assistant Administrator Sammy Lee.The facility had submitted a Special Incident Report (SIR) to Community Care Licensing stating that a resident was found bleeding from the forehead for an unknown reason. The resident was subsequently transported to the hospital, where stitches were administered.LPA interviewed Resident 1 (R1), who was alert and able to comprehend and respond to questions. R1 reported that they slipped in the restroom, which caused the forehead injury. LPA reviewed the hospital discharge paperwork, which confirmed that no fracture was identified.An exit interview was conducted, and a copy of this report was provided to the facility.

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced case management visit to the facility in response to a self-reported Unusual Incident Report. Upon arrival, LPA Haddadin was greeted by Executive Director Susan Lee, who granted access to the facility, at which time the purpose of the visit was explained. According to the incident report, on September 12, 2025, Resident 1 (R1) sustained a maxillofacial fracture as a result of a fall. LPA Haddadin obtained copies of R1’s file, including medical records and recent hospital discharge paperwork related to the incident. Records confirmed that R1 is ambulatory and able to walk independently; however, as a precaution, R1 uses a walker. LPA Haddadin conducted interviews with four staff members, all of whom consistently reported that R1 had exited their room without the walker and was standing at their doorway when staff approached to retrieve the walker from the room. At that moment, R1 fell forward. Facility staff immediately contacted emergency services, and R1 was transported to Anaheim Regional Center, where they were treated and discharged the same day. LPA Haddadin also interviewed R1 and observed them resting in bed. When asked about the incident, R1 stated they became dizzy just outside their room. When asked about pain, R1 denied experiencing pain and stated they were preparing to attend a Bingo activity. Based on interviews and record review the preponderance of evidence has not been met; therefore the allegation is deemed unsubstantiated

LPA also reviewed staff records and verified that all Med-Tech staff had completed the required eight-hour medication training course. An interview with R1 was also conducted, during which R1 denied the allegations. Regarding the allegation that the “Facility failed to report incident to the Department,” it was determined that no reporting was required because the alleged medication error did not occur. Based on the information obtained through interviews, document review, and observations, the above allegations are determined to be unfounded. This means the allegations are false, could not have occurred, and/or have no reasonable basis. An exit interview was conducted, and a copy of this report was discussed with and provided to the facility representative.

The incident occurred in the Memory Care Unit when R1 mistakenly entered another resident’s room, believing it was their own. The other resident struck R1, which resulted in the bruise. Documentation showed that facility staff immediately applied first aid and offered to transport R1 to urgent care, which R1 declined. Facility records indicate that R1’s primary physician was notified of the incident. Furthermore, staff relocated the other resident involved to a different apartment unit to prevent future incidents. Review of R1’s physician report states that R1 was able to communicate their needs and reported no pain when assessed. As to the allegations that staff do not ensure the facility is clean, orderly, and odor-free, LPA Haddadin conducted a facility walk-through, inspecting resident rooms, common areas, and restrooms. LPA did not observe any evidence supporting the allegations. Resident interviews confirmed that the facility did not have issues with cleanliness or odors of incontinence. LPA observed that each resident’s door displayed a housekeeping schedule indicating that rooms are cleaned twice a week, as well as upon request. Facility records included both a Janitorial Cleaning Schedule, which documents cleaning of common areas, and a Housekeeping Cleaning Schedule, which tracks resident rooms cleaned on assigned service days. Both record review and direct observations corroborated that cleaning protocols are in place and followed. Five of five staff interviews and five of five resident interviews denied the allegations. 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 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 provided to the facility representative.

Licensing Program Analyst (LPA) Samer Haddadin made an unannounced case management site visit to the facility. LPA arrived at facility was greeted at the door by staff and granted entry. LPA met with Susan Lee, Executive Director and explained the nature of today's visit. During the visit, LPA conducted a health and safety check and observed no irregularity. LPA checked the memory-care building and observed no violations. Based on observations, no deficiencies are being cited . An exit interview was conducted and a copy of this report was provided to the facility Executive Director, Susan Less.

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.

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced Case Management . LPA Haddadin was granted entry into the facility and met with Administrator (AD) Susan Lee, to whom the purpose of the visit was explained. During today's visit, LPA Haddadin conducted an interior and exterior walk of the facility LPA also checked hot water temperature in 6 different resident's rooms ( 111.1-117.2DF). LPA checked memory care unit and made sure chemicals and sharps are locked. No violation noted An exit interview was conducted with AD, and a copy of this report was also provided

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.

Licensing Program Analyst (LPA) Samer Haddadin made an unannounced case management site visit to the facility. LPA arrived at facility was greeted at the door by staff and granted entry. LPA met with Susan Lee, Executive Director and explained the nature of today's visit. During the visit, LPA conducted a health and safety check and observed no irregularity. LPA checked hot water in 6 different rooms and measured between 115.5 and 118,5 F.D. Based on observations, no deficiencies are being cited at this time. An exit interview was conducted and a copy of this report was provided to the facility Executive Director, Susan Less.

Licensing Program Analyst (LPA) Ruth Martinez made an unannounced case management site visit to the facility.LPA arrived at facility was greeted at the door by staff and granted entry. LPA met with Susan Lee, Executive Director and explained the nature of today's visit. The purpose of this visit is to further investigate a complaint under control #AS-22-20240626135527 and deliver an amended complaint report originally issued on September 9, 2024. Exit interview was conducted with facility representative and a copy of this LIC809 report was left at facility along with copies of amended reports.

Licensing Program Analyst (LPA) Samer Haddadin is conducting this unannounced visit for the purpose of a health and safety check. LPA arrived at the facility was greeted and granted entry by Administrator (AD) Susan Lee. LPA gathered paper work for Resident (R1): physician report, hospice records, admissions records, appraisal record as well as Radiology report from K&T Portable X-ray. Based on observations, no deficiencies are being cited at this time. An exit interview was conducted and a copy of this report was provided to the facility Executive Director, Susan Less.

Licensing Program Analyst (LPA) Samer Haddadin is conducting this unannounced visit for the purpose of conducting a health and safety check. LPA arrived at the facility was greeted and granted entry by Administrator (AD) Susan Lee. LPA toured the facility and as well as memory care unit. Facility seems to be sanitary and clean. LPA observed the pub 456 sign to be within the regulatory posting size. LPA asked AD to have another sign in employee lounge due to the size of the building . LPA observed the facility Emergency food and water to be within regulatory requirements. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and provided to AD at end of inspection.

It was alleged that a resident’s room does not get cleaned and is always dirty and full of trash and diapers. LPA inspected the assisted living section and memory care unit, 17 resident bedrooms, and all common areas and hallways and LPA’s observations did not corroborate the allegation. LPA interviewed 20 residents and did not obtain information corroborating the allegation. LPA interviewed AD who denied the allegation, stating that resident rooms are cleaned twice a week unless the resident refuses and that refusals are rare. Per AD, there are an average three housekeepers on each day shift to clean the facility. LPA reviewed the facility’s staff schedule which shows there are an average of three housekeepers scheduled for each day shift depending on the day of the week. The information obtained did not corroborate the allegation. Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.

On 10/28/2024, LPA Mason made an unannounced visit to the facility for the purpose of conducting a plan of corrections follow-up. LPA arrived and was greeted and granted entry by Executive Driector Susan Lee. On 10/15/2024 LPA Mason issued deficiencies pertaining to the following Title 22 Regulation: 87555 General Food Service Requirements (20) Food preparation equipment shall be placed to provide aisles of sufficient width to permit easy movement of personnel, mobile equipment and supplies. and 87555 General Food Service Requirements (21) Freezers of adequate size shall be maintained at a temperature of 0 degrees F (-17.7 degrees C), and refrigerators of adequate size shall maintain a maximum temperature of 40 degrees F (4 degrees C). LPA toured the kitchen and made the following observations: LPA observed the two-burner stove to be removed from the kitchen and replaced with a one-burner stove that does not extend into the walkway. LPA observed the refrigerator temperature to be set to 40 degrees F and the freezer temperature to be set to -10 degrees F. LPA also answered questions from ED regarding resident room assignments and reporting requirements. Based on today's inspection, LPA determined the facility fulfilled their plans of correction. An exit interview was conducted and a copy of this report was provided.

CONTINUED FROM LIC9099 Regarding the allegation that Facility is not ensuring the facility is kept at a comfortable temperature , the following has been concluded: On the day of the visit, outside temperatures in Anaheim had reached a high of 105F. Throughout the facility, hallways, common areas, dining halls and living units were all verified to be served by functional air conditioning units. Administrator stated A/C unit filters had been replaced on the day of the follow-up visit. Room temperature measured throughout ranged from 72F to 82F in some units were residents had opted to temporarily inactivate the air conditioning. Similar observations had been conducted during the initial visit on a day with lower outside temperatures. Two of the residents interviewed were able to corroborate that their units had functioning air conditioning and that they individually were able to set the room temperature comfortably for themselves. Additionally, a similar allegation was investigated as part of complaint investigation 22-AS-20240610155726 and found to be Unsubstantiated. Regarding the allegation that Food portions are insufficient for the residents' nutritional needs , the following has been concluded: A total of six resident interviews were conducted. None of the residents interviewed stated that the portions were insufficient. Two residents stated that on occasion they requested for a second serving but also confirmed they received that additional portion whenever requested. Staff interviews conducted confirmed that the food supply on hand is sufficient. Regarding the allegation that Facility is not sufficiently staffed for residents with special needs , the following has been concluded: The morning shift was confirmed to have 8 to 9 caregivers on hand every day scheduled. The afternoon shift also had a usual full staffing of 8 caregivers each day while there are three caregivers actively assigned to the night shift in the memory care. The wide majority of caregivers during the two daytime shifts are assigned to the memory care, with usually 4 caregivers present on the second floor of the unit and two present on the ground floor. Staffing levels were verified through the facility's payroll records as well as observation conducted during the first visit which both concluded that the actual staffing levels observed corresponded to the schedule provided. As a result, all three allegations are found to be Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute that the alleged violations occurred. An exit interview was conducted and a copy of this report was provided to a facility representative.

LPA is unable to corroborate the allegation. Therefore, the allegation is deemed unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted and a copy of this report was provided to facility.

Licensing Program Analyst (LPA) Joseph Alejandre conducted an announced visit to the facility to conduct the pre-licensing inspection. LPA met with Administrator Christine Chon and Eric Chang and toured the facility. An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to CCL on October 30, 2023. The facility is to have a capacity of 199, of which 194 can be nonambulatory and 5 bedridden. Applicant has requested a hospice waiver for 25 residents. Facility phone number 714-459-3353 . LPAs observed the following. Structure: The facility is a three story building with an interior courtyard with a fountain and an attached parking garage. The fountain is surrounded by flowers and not accessible to residents. Facility has 112 resident rooms. Each resident room has it's own bathroom. There is an outdoor patio at the back of the building for residents to sit outside. The back patio and interior courtyard both have shaded areas for resident to sit outside. There are 5 stairwells in the building. LPA observed all 5 stairwells had an emergency evacuation chair. LPA observed the PUB 475 poster posted in the entry way of the facility. LPA observed a sitting room with books and places to sit next to the main entrance of the facility. Air/Heating: Central air/heating system installed in the building. Resident Bedrooms: All resident bedrooms are spacious and will easily accommodate the residents' belongings. All resident rooms had the required furnishings. There are resident rooms on all three floors of the building. Per fire clearance, bedridden is only to be allowed on the fist floor. Memory care is on the first and second floor. The third floor is for ambulatory residents only. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Bathrooms: All resident bathrooms inspected were clean and operational. Linens & Hygiene Supplies: Adequate supply of linen stored throughout the facility. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menus posted and available. Menus prepared one week in advance. Food Service: LPA observed the kitchen is clean and operational. LPA observed a 2 day perishable and a 7-day non-perishable food supply on hand. Smoke Detectors/Carbon Monoxide Detectors: Smoke detectors/carbon monoxide detectors tested operational. There are fire extinguishers mounted throughout the facility on each floor. All fire extinguishers are fully charged. Appliances: All appliances in the kitchen are clean and operational. All washers and dryers in the laundry room which is located in the parking garage are operational. The laundry room is off limits to residents. Toxins: All cleaning supplies and chemicals are kept locked in storage closets throughout the facility. Water Temperature: Hot water measured in resident bathrooms measured between 104.0 to 120.5 degrees Fahrenheit. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Medications, First-Aid Kit & Book: The first aid kit and the first aid manuals are stored in the medication room on the first floor and in memory care. All the first aid kits had the required elements. Medication is kept locked in the medication room. Resident & Staff Files : The Resident and Staff Records will be kept locked in the facility office. Reading Material, Games, Equipment & Materials: There is an activity room on the third floor. There is a TV in the movie room on the first floor. There are board games, card games and arts and craft supplies. The monthly activity calendar is posted in the main lobby and dining room. Fire clearance: Fire Clearance approved by Anaheim Fire Department, fire Inspector Adam Graef on December 15, 2023. The facility is approved for delayed egress and secured perimeter for the memory care unit on the first and second floors. Component III: Component three was completed with the Licensee's representative (Administrator). . The facility is ready to be licensed. Administrator was informed today that the final approval will be processed by CAB (Central Applications Bureau) in Sacramento. Exit interview was conducted and a copy of this report was left with the Administrator.

Facility Type: RCFE Application Type: CHOW Capacity: 199 Census (if any clients in care): 170 Interview Method: Telephone interview On 2/28/2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readiness