Harbor Heights Assisted Living and Memory Care

Allegation investigated: Staff do not serve residents nutritious meals Staff do not provide adequate laundry services Staff are not able to communicate effectively with residents

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegations received on April 14, 2026. LPA was greeted and granted entry into the facility and met with Executive Director (ED) Susan Lee. LPA explained the reason for the visit. This Department has investigated the complaint alleging that staff do not serve residents nutritious meals. Regarding the allegation the following was revealed: During the interviews conducted five of nine individuals interviewed denied the allegation. During the investigation LPA reviewed the Harbor Heights Assisted Living and Memory Care American and Korean food menus dated April 20, 2026, through April 26, 2026, and June 15, 2026, through June 21, 2026. Per food menus, the residents are offered a variety of meals such as pancakes, turkey sandwich, BBQ chicken, kimchi, rice, pasta, grilled fish, shrimp fried rice, fruit and salad. During the interviews with residents, Resident 1 (R1) reported that meals are good and stated that she can choose a Korean or American meal. Per R2 and R3, staff serve nutritious meals and reported that CONTINUED ON LIC9099-C... Unsubstantiated they eat enough vegetables and protein. During the interviews with staff, Staff 1 (S1) reported that staff are serving the residents nutritious meals. During the interviews the ED reported that the residents are provided with nutritious meals and stated that the meals have enough vegetables and protein. Regarding the allegation that staff do not provide adequate laundry services, the following was revealed: During the investigation LPA reviewed the Harbor Heights Assisted Living and Memory Care laundry schedule. Per laundry schedule, the residents are provided with laundry services every week. During the interviews with residents, R1 reported that her clothes are cleaned good and stated that some clothes go missing but she is not sure. Per R2, he has never been missing clothes. R3 stated that staff provide good laundry services. During the interviews with staff, S2 reported that staff provide adequate laundry services. S3 stated that staff use a magnetic tag to identify each load of clothes. Per S2, the clothes can get misplaced by the residents. Regarding the allegation that staff are not able to communicate effectively with residents, the following was revealed: During the initial visit on April 22, 2026, and subsequent visit on June 15, 2026, LPA tour the facility and observed the residents communicating effectively with staff. During the interviews with residents, R1 reported that she is able to communicate with staff. Per R2 and R3, staff are able to communicate effectively with residents and/or stated that they have no issues. During the interviews with staff, S1 reported that staff can communicate with the residents and stated that some staff speak both English and Korean. Per S2 and S5, staff are able to communicate effectively with the residents. S4 reported that staff can communicate with the residents perfectly fine. 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 ED Lee, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jun 15, 2026 · control 22-AS-20260414084036

Allegation investigated: Facility is not providing planned activities to resident

Licensing Program Analyst (LPA) Samer Haddadin conducted an announced visit to the facility to deliver findings regarding the above-mentioned allegation. Upon arrival, LPA was greeted and granted entry by Administrator Suzan Lee. LPA explained the purpose of the visit. The Department received a complaint alleging that the facility is not providing planned activities to a resident. Specifically, the complaint alleged that a resident (R1), identified by first name only, was not being provided activities by facility staff. At the time of the visit, the facility had 196 residents in care. During the investigation, LPA reviewed the resident roster and staff schedule. LPA could not locate (R1) on the resident roster, and no resident name matched the information provided in the complaint. LPA also reviewed the facility’s planned activity calendar. The facility maintains a monthly activity calendar, which is posted in the dining area, front lobby, and inside the activity room located on the first floor. {***CONTINUE 9099C***} Unsubstantiated During the visit, LPA observed residents in both the Assisted Living (AL) and Memory Care (MC) units participating in activities, including arts and puzzles. The activities observed were consistent with the activities listed on the facility’s activity calendar. LPA conducted five staff interviews. Five out of five staff interviewed denied the allegation and stated that planned activities are provided to residents. Staff also stated that they were not familiar with R1’s name as provided in the complaint and had not heard of a resident by that name. Staff reported that residents are encouraged to participate in activities; however, participation is based on each resident’s preference and willingness to attend. LPA also conducted five resident interviews. Residents interviewed confirmed that the facility provides planned activities, including bingo, supervised exercises, playing cards, and other activities reflected on the monthly activity calendar. Residents stated that activities are available and that residents may choose whether they want to participate. Based on interviews conducted, records reviewed, observations made, and information obtained during the investigation, LPA did not find sufficient evidence to support the allegation. Although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove that the facility failed to provide planned activities to the resident. Therefore, the allegation that “Facility is not providing planned activities to resident” is deemed Unsubstantiated. An exit interview was conducted with Administrator Suzan Lee, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 4, 2026 · control 22-AS-20260601163814

Allegation investigated: -Staff do not ensure residents was adequately hydrated 2-Staff do not assist residents self-administer their medication

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 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***) 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.the state’s words, verbatim · CDSS document, May 31, 2026 · control 22-AS-20240814155709

Allegation investigated: -Staff leave residents in soiled clothing for extended periods of time 2-Staff do not ensure residents are bathed 3-Staff do not prevent residents from engaging in physical altercations which result in injuries

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 Assistant Administrator Sammy Lee, who granted entry into the facility. LPA explained the purpose of the visit. Administrator Susan Lee arrived shortly thereafter. 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 progress notes, admission records for Resident 1 (R1) and Resident 2 (R2), bathing schedules for March 2026 and April 2026, and Special Incident Reports (SIRs). LPA also conducted a digital record review with the Community Care Licensing Division and did not locate any Special Incident Reports submitted by the facility for the period of February 2024 through December 2024 related to the allegations. {***CONTINUE 9099C***) Unsubstantiated Regarding the allegations that “Staff do not ensure residents are bathed” and “Staff leave residents in soiled clothing for extended periods of time,” the complaint alleged that residents were left unbathed, remained in the same clothing for several days, and were provided showers or clean clothing only when family members visited. During the investigation, LPA reviewed facility progress notes, admission records, and bathing schedules. Facility records showed that the facility maintains a set bathing schedule for residents who require assistance with personal care. The schedule reflects that residents who need assistance are scheduled to be bathed twice per week and may also be bathed upon request. LPA reviewed the current bathing schedules for March 2026 and April 2026, which corroborated the statements provided by the residents interviewed regarding bathing assistance. LPA also interviewed staff and residents regarding bathing schedules, care needs, toileting assistance, and personal hygiene. Six out of six staff members interviewed denied the allegations; also, six out of six residents interviewed denied the allegations and did not report being denied bathing assistance or being left in soiled clothing. Furthermore, during the tour, LPA did not observe conditions that would support the allegations. LPA conducted resident interviews in the residents’ respective living areas and did not detect odors associated with incontinence. LPA observed that the residents appeared well-groomed, and sufficient hygiene supplies were observed in the residents’ restrooms. Based on interviews conducted, records reviewed, and observations made during the investigation, the Department did not obtain sufficient corroborating 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. LPA attempted to identify the residents referenced in the August 2024 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 prevent residents from engaging in physical altercations which result in injuries,” the complaint alleged that residents engaged in physical altercations and that one resident sustained a bruise to the upper lip. During the investigation, LPA reviewed facility progress notes, admission records for R1 and R2, and facility SIRs. LPA also conducted interviews with staff and residents regarding resident-to-resident interactions, staff supervision practices, and whether residents observed physical or verbal aggression toward residents or staff. R1 and R2 were not available to be interviewed, as both residents no longer resided at the facility. LPA attempted to contact the responsible parties for R1 and R2; however, the contact information for R2’s responsible party was not accurate, and R1’s responsible party declined to be interviewed. Six out of six staff members interviewed denied that physical altercations resulting in injuries occurred. Staff acknowledged that there have been instances of verbal disagreements or verbal aggression between residents; however, staff denied that these interactions escalated into physical altercations, hospitalization, or injuries to residents. Six out of six residents interviewed denied witnessing any physical or verbal aggression toward residents or staff. LPA reviewed both residents’ files and did not locate any hospital discharge records or documentation indicating that either resident sustained injuries or was hospitalized due to a physical altercation or bruising. Furthermore, facility SIRs reviewed did not show any incidents of physical altercations, verbal aggression requiring incident reporting, hospitalization, or injuries related to resident-to-resident altercations. Records reviewed for the period of February 2024 through December 2024, records did not show any incidents that resident-to-resident physical altercations or resulting injuries. {***CONTINUE 9099C***)the state’s words, verbatim · CDSS document, May 30, 2026 · control 22-AS-20240814155709

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced case management visit to the facility regarding an Unusual Incident Report (UIR) received by the Department on April 22, 2026. Upon arrival, LPA was greeted and granted entry into the facility by Case Manager April Pena. LPA explained the purpose of the visit. The UIR stated that Resident 1 (R1) left the facility unassisted and was returned to the facility by the police department. During today’s visit, LPA discussed the incident with Case Manager and obtained additional information regarding the circumstances surrounding the incident. LPA also reviewed relevant facility records, including R1’s Physician’s Report, LIC 602 form. Records review noted that R1 cannot leave the facility unassisted and that R1 has mild cognitive impairment. Based on the information obtained during today’s visit, the facility failed to provide adequate care and supervision to R1 when R1 left the facility unassisted and was returned by the police department. One deficiency is being cited pursuant to Title 22, California Code of Regulations.An exit interview was conducted with Case Manager, Pena, and a copy of this report, along with appeal rights, was provided to the facility.the state’s words, verbatim · CDSS document, May 20, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: May 21, 2026

87464(f)(1) Basic Services The licensee shall provide care and supervision. This requirement was not met as evidenced by: Based on and records reviewed, the licensee failed to provide adequate care and supervision to Resident 1 (R1). R1 exited the facility unsupervised and was returned to the facility by the police department. This posed an immediate health and safety risk to R1.the state’s words, verbatim · CDSS document, May 20, 2026

Plan of correction: Licensee shall ensure a designated staff member is stationed at the exit door at all times to monitor residents who are unable to leave the facility unassisted.

Type of visit: Case Management - Incident

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.the state’s words, verbatim · CDSS document, May 19, 2026

Allegation investigated: 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

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 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. 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... 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.the state’s words, verbatim · CDSS document, Apr 10, 2026 · control 22-AS-20250226095550

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Apr 13, 2026

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 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.the state’s words, verbatim · CDSS document, Apr 10, 2026

Plan of correction: 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.

Type of visit: Required - 1 Year

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***} 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.the state’s words, verbatim · CDSS document, Apr 9, 2026

Type of visit: Case Management - Other

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.the state’s words, verbatim · CDSS document, Apr 1, 2026

Allegation investigated: Resident fell due to alleged neglect.

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility to deliver findings regarding the above-mentioned allegation. Upon arrival, LPA met with Sammy Lee, Administrator Assistant, and explained the purpose of the visit. During the investigation, LPA conducted a record review, obtained and reviewed facility documents, completed a facility walk-through, and conducted five staff interviews and five resident interviews. It was alleged that Resident 1 (R1) “fell due to alleged neglect.” LPA conducted five staff interviews and five resident interviews, and all denied the allegation. LPA also interviewed R1, who stated that they became dizzy while in the hallway and fell. During staff interviews, two staff members reported that they assisted R1 immediately after the fall, contacted emergency services, and arranged for R1 to be transported to a local hospital. Staff also stated that R1’s responsible party (RP) was notified right away. {***CONTINUE9099C***} Unsubstantiated 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.the state’s words, verbatim · CDSS document, Mar 24, 2026 · control 22-AS-20260127120310

Allegation investigated: Staff failed to properly supervise residents, resulting in falls. Staff are not properly trained Staff did not clean resident rooms Staff did not provide proper medication assistance. Staff left residents in soiled diapers too long, causing a rash. Staff lacked adequate infection-control supplies.

Licensing Program Analyst (LPA) Samer Haddadin conducted an announced visit to the facility to deliver findings regarding the above-mentioned allegations. Upon arrival, LPA met with Case Manager (CM) April Pena and explained the purpose of the visit. During the course of the investigation, LPA reviewed and obtained relevant records, interviewed staff and residents, conducted a health and safety walk-through, and documented observations. Regarding the allegation, “Staff lacked adequate infection-control supplies,” LPA interviewed four staff members and four residents, all of whom denied the allegation. In addition, during the health and safety walk-through, LPA observed that the facility maintained Personal Protective Equipment (PPE) in three storage areas. One storage area was located on the first floor behind the reception desk, another was located in the administration office on the first floor, and additional PPE was stored in the memory care unit. {***CONTINUE9099C***) Unsubstantiated 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***) 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.the state’s words, verbatim · CDSS document, Mar 20, 2026 · control 22-AS-20260211155055

Type of visit: POC

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 state’s words, verbatim · CDSS document, Feb 12, 2026

Allegation investigated: Facility staff do not provide quality meals to residents

On February 3, 2026, Licensing Program Analyst (LPA) Samer Haddadin conducted an announced visit to the facility to deliver findings regarding the investigation of the following allegation: “Facility staff do not provide quality meals to residents.” Upon arrival, LPA Haddadin met with Case Manager April Pena to explain the purpose of the visit and the scope of the investigation. The investigation process included direct observation, interviews with four staff members and four residents, and a thorough review of relevant facility records. During these interviews, all four staff members and all four residents denied the allegation, stating that the quality of the meals provided is satisfactory. LPA Haddadin conducted a comprehensive walkthrough of the kitchen area, which was observed to be clean, organized, and entirely free of mold or mildew. {***CONTINUE9099C***} Unfounded 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.the state’s words, verbatim · CDSS document, Feb 3, 2026 · control 22-AS-20260126122321

Allegation investigated: Staff did not notify authorized representative of medication changes

Regarding the allegation: Staff did not notify authorized representative of medication changes During the investigation, interviews were conducted with 6 individuals including facility staff and a medical professional. During an interview with Witness 1 (W1), it was confirmed that on December 6, 2024, one of R1’s medications was changed from being administered once a day, to being administered two times per day according to W1. During interviews with facility staff, it was confirmed R1’s family was not notified regarding the medication change. Based on the evidence gathered through interviews, the preponderance of evidence standard has been met, therefore, the allegation above is found to be SUBSTANTIATED. A violation is being cited per California Code of Regulations Title 22. An exit interview was conducted, and a copy of this report and appeal rights were provided. Substantiatedthe state’s words, verbatim · CDSS document, Jan 22, 2026 · control 22-AS-20251211092635

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(f) · Plan of correction due date: Feb 25, 2026

87463(f) Reappraisal (f) The licensee shall immediately, or as soon as reasonably possible, communicate with the resident and, if applicable, the resident's representative, about any significant change in condition and the recommendation, if any, of the appropriate licensed medical professional, and if applicable, other specialized care provider. Documentation of such communication shall be added to the resident’s record. This requirement is not being met as evidenced by: Facility staff failed to notify Resident 1 (R1) family of a medication change ordered December 6, 2024. This poses a potential health and safety risk for residents in care.the state’s words, verbatim · CDSS document, Jan 22, 2026

Plan of correction: Facility representative agrees to review the regulation requirement and send a signed statement of acknowledgement and understanding to LPA Haley. Facility representative agrees to email the POC to LPA Haley by 5:00pm on the POC due date.

Allegation investigated: Staff did not notify authorized representative of incident

Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to investigate the complaint allegation listed above. LPA Haley explained the reason The complaint investigation consisted of interviews and document review. Regarding the allegation: Staff did not notify authorized representative of incident During the investigation, Staff 1 (S1) provided an incident report dated December 11, 2024 regarding Resident 1’s (R1) fall. On the report it indicates which family member was called, and what time the family member was called. There’s also a note on the incident report that states multiple calls were made to the family member and the phone either goes straight to voicemail or that number is out of service. Additional document review revealed an email from a family member of R1 dated December 12, 2024, at Continued on LIC9099C Unfounded 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.the state’s words, verbatim · CDSS document, Jan 22, 2026 · control 22-AS-20251211092635

Type of visit: Office

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.the state’s words, verbatim · CDSS document, Jan 22, 2026

Allegation investigated: Administrator does not meet Title 22 regulatory qualification requirements. Facility emergency backup generator is inoperable Facility laundry area was constructed without fire clearance Facility does not have sufficient staff to meet resident needs

Licensing Program Analyst (LPA) Samer Haddadin conducted an announced visit to the facility to deliver findings regarding the above-mentioned allegations. Upon arrival, LPA met with Case Manager (CM) April Pena and explained the purpose of the visit. It was alleged that the administrator does not meet Title 22 regulatory qualification requirements, the facility’s emergency backup generator is inoperable, Facility does not have sufficient staff to meet resident needs, and the facility laundry area was constructed without fire clearance. The investigation included direct observation, interviews with staff members and residents, and a review of relevant facility records. Regarding the allegation that the administrator does not meet Title 22 regulatory qualification requirements and the allegation that the facility does not have sufficient staff to meet resident needs, {***CONTINUE 9099C***} Unfounded 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.the state’s words, verbatim · CDSS document, Jan 16, 2026 · control 22-AS-20251022115344

Type of visit: POC

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 7th, the deficiency was not corrected and a civil penalty was assessed. As of January 15th, 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.the state’s words, verbatim · CDSS document, Jan 15, 2026

Type of visit: POC

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.the state’s words, verbatim · CDSS document, Jan 7, 2026

Allegation investigated: Staff is not providing mandated one-on-one supervision to residents on the Resident Habilitative Program

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility to deliver the findings regarding the above-mentioned allegation.LPA met with Sammy Lee, the Administrator Assistance and explained the reason of the visit. During the investigation, LPA Haddadin conducted a record review, obtained and reviewed facility documents, completed a facility walk-through, and conducted six interviews. It was alleged that staff were not providing the mandated one-on-one supervision required for residents enrolled in the Resident Habilitative (RH) Program. The RH Program is authorized through the Assisted Living Waiver (ALW) Program for residents who require increased care and supervision. The facility had four residents receiving RH services at the time of the visit. Resident 1 (R1) was approved for 10 hours of one-on-one supervision, Resident 2 (R2) was approved for 14 hours, Resident 3 (R3) was approved for 16 hours, and Resident 4 (R4) was approved for 16 hours. During the walk-through, LPA Haddadin did not observe any of the RH-qualified residents receiving one-on-one supervision. {***Continue 9099C***} Substantiated Additionally, the reappraisals for the RH-qualified residents were not updated to reflect the required level of care and supervision. LPA Haddadin interviewed six staff members. All staff interviewed stated that the RH-qualified residents were not receiving the full number of approved one-on-one supervision hours. LPA Haddadin also attempted to interview the RH-qualified residents; however, due to cognitive and mental disabilities, LPA was unable to obtain reliable statements from the residents. Based on observations, record review, and interviews, the preponderance of evidence standard has been met. Therefore, the allegation, “Staff is not providing mandated one-on-one supervision to residents on the Resident Habilitative Program,” is substantiated. The facility is being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted, and a copy of this report, including Appeal Rights and Confidential Names, was provided. Based on interviews, record review, and observations, the preponderance of evidence standard was not met. Therefore, the allegation, “Staff is not ensuring residents’ bathing needs are being met,” is unsubstantiated. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 2, 2026 · control 22-AS-20251121155401

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Jan 5, 2026

87411(a)"...agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services." This requirement is not being met as evidenced by record review and interviews: Licensee did not provide the one-on-one care for residents which poses an immideate health and safety to residents in carethe state’s words, verbatim · CDSS document, Jan 2, 2026

Plan of correction: Facility will keep record of of all RH residents and maintain the one-on-one staff for qualified residents and log hours. and send proof to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(b) · Plan of correction due date: Jan 9, 2026

87463(b)"reappraisal shall document changes in the resident's physical, mental, cognitive, behavioral, or functional condition,as specified in Section 87466" This requirement is not being met as evidenced by record review. Licensee did not maintain updated reappraisal for four out of four residents which poses a potential health and safety to residents in carethe state’s words, verbatim · CDSS document, Jan 2, 2026

Plan of correction: Licensee to update reappraisal documents for residents and send proof to LPA by POC due date

Type of visit: Case Management - Incident

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***} 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.the state’s words, verbatim · CDSS document, Jan 2, 2026

Type of visit: Case Management - Incident

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.the state’s words, verbatim · CDSS document, Dec 17, 2025

Type of visit: Case Management - Other

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.the state’s words, verbatim · CDSS document, Nov 26, 2025

Type of visit: Case Management - Other

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.the state’s words, verbatim · CDSS document, Nov 12, 2025

Allegation investigated: Staff does not provide food of nutritional quality

Licensing Program Analyst (LPA) Samer Haddadin conducted an announced visit to the facility to deliver findings regarding the investigated allegation: “Staff does not provide food of nutritional quality.” Upon arrival, LPA met with Assistant Director (AD) Sammy Lee and explained the purpose of the visit. The investigation included direct observation, interviews with four staff members and four residents, and a review of relevant facility records. All four staff members interviewed denied the allegation. Similarly, all four residents interviewed also denied the allegation. LPA conducted a walkthrough of the kitchen and observed the area to be clean, organized, and free of mold or mildew. LPA reviewed two food menus: one American and one Korean. Both menus are available for all residents to choose from. During the visit, LPA observed residents having lunch, which included an egg sandwich served with chips and assorted fresh fruits such as grapes, watermelon, and mango. Unfounded 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.the state’s words, verbatim · CDSS document, Oct 28, 2025 · control 22-AS-20251022115344

Type of visit: Case Management - Incident

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.the state’s words, verbatim · CDSS document, Oct 3, 2025

Type of visit: Case Management - Incident

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.the state’s words, verbatim · CDSS document, Sep 26, 2025

Type of visit: Case Management - Incident

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 unsubstantiatedthe state’s words, verbatim · CDSS document, Sep 16, 2025

Allegation investigated: Facility mismanaged Resident's medication Facility failed to report incident to the department

On September 11, 2025, Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility to deliver the findings regarding the above allegations. Upon arrival, LPA Haddadin met with Executive Director Susan Lee, explained the purpose of the visit, and was granted entry into the facility. The investigation addressed the allegations that the “Facility mismanaged Resident’s medication” and that the “Facility failed to report incident to the Department.” It was alleged that on August 27, 2025, and August 28, 2025, Resident 1 (R1) was not administered their prescribed medication and that the incident was not reported to Community Care Licensing. LPA Haddadin conducted four staff interviews and four resident interviews. All parties denied the allegations. A review of R1’s Medication Administration Record (MAR) confirmed that the medication had been properly administered on both dates. In addition, three random MARs belonging to three other residents were reviewed, and all reflected accurate and timely administration of medications. Unfounded 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 state’s words, verbatim · CDSS document, Sep 11, 2025 · control 22-AS-20250903093211

Allegation investigated: Resident sustained an injury due to lack of supervision Staff do not ensure facility is clean and orderly Staff do not ensure facility is odorless

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced complaint visit to the facility to deliver findings regarding the above allegations. Upon arrival, LPA Haddadin met with Administrator, Susan Lee, and advised her of the purpose of the visit. During the course of the investigation, LPA Haddadin conducted five (5) staff interviews and five (5) resident interviews. All staff and residents interviewed denied the following allegations: “Resident sustained an injury due to lack of supervision,” “Staff do not ensure facility is clean and orderly,” and “Staff do not ensure facility is odorless.” LPA Haddadin also reviewed facility records, staff records, and resident records. It was alleged that a resident sustained an injury due to lack of supervision. Record review revealed that Resident 1 (R1) had sustained a bruise to the left eye. {***CONT*** 9099C} Unsubstantiated 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.the state’s words, verbatim · CDSS document, Sep 4, 2025 · control 22-AS-20250820103207

Type of visit: Case Management - Health Checks

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.the state’s words, verbatim · CDSS document, Aug 26, 2025

Allegation investigated: 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

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 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.the state’s words, verbatim · CDSS document, Aug 20, 2025 · control 22-AS-20250528081707

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility for the purpose of delivering finding regarding case management conducted on March 07, 2025. LPA Haddadin was greeted by Assistant Executive Director, Sammy Lee who granted access to the facility, at which time the purpose of the visit was explained. On March 03, 2025, the Regional Office received a self-reported unusual incident report from the facility reporting the hospitalization of Resident 1 (R1) resulting in a bone fracture. A case management health and safety visit was then completed on March, 07th, 2025. The investigation determined as follows: A review of facility and medical records established that Resident 1 (R1) has a documented history of Parkinson’s Disease with progressive physical decline, intermittent confusion, and Mild Cognitive Impairment, as reflected in a Physician’s Report dated May 10, 2022. Internal Incident Reports from October of 2024 to February 12, 2025, show that R1 experienced at least eight unwitnessed falls despite existing fall-risk measures developed by the Assisted Living Waiver Program (ALW). A review of R1's Individual Service Plan assessed by the dated February 6, 2025, to August 6, 2025, R1 was identified as having poor safety awareness and being at high risk for falls. A fall mitigation plan had been developed by the ALW and recommended to manage these risks. {***CONTINUE 809C***} Per review of R1’s file, the facility failed to conduct an appraisal of R1’s needs. The most recent unwitnessed fall occurred on February 12, 2025, around 10 A.M. Following the fall, facility staff contacted R1’s hospice agency. Hospice agency notes dated February 12, 2025, document that a hospice nurse visited R1 at 1:15 P.M. During the visit, R1 was alert but confused, able to communicate, and reported severe, constant pain in the left arm and shoulder, grimacing with movement. Assessment revealed swelling in the left anterior shoulder, but no visible bruising was present at that time. Although R1 could move and bend the shoulder slowly, it caused significant discomfort. Hospice ordered pain medication for R1 and instructed staff to monitor for worsening pain and to contact hospice if medication was not effective. Photographic evidence from February 14, 2025, depicted significant bruising and edema on R1’s left upper extremity. Facility staff notes on February 14, 2025, at 7:40 p.m. documented a call from MedTech (MT) to the Administrator requesting transfer for hospital evaluation; however, after consulting with R1’s hospice doctor, the decision was made to keep R1 at the facility. Hospice nurse assessed R1 and noted shortness of breath, significant pain, and swelling in the left upper extremity (LUE) and bruising from the shoulder to the elbow. R1 was found lying in bed and was unable to move the left arm, an observed decline from two days earlier, when limited movement was still possible. Pain was reported as severe, consistent with a pain scale of 10/10 with movement. R1 required complete assistance with all activities of daily living (ADLs), including feeding, bathing, dressing, toileting, turning, and mobility. Hospice agency ordered an X-ray and provided new orders for medication and treatment for R1. R1’s family was informed and agreed not to transfer R1 to the hospital, however the R1 was not conserved and had no POA. Even though Hospice agency instructed facility staff to apply an ice pack and monitor changes and report them, the facility staff did not complete any further post-fall monitoring observations or progress notes from February 14 through February 22, 2025. On February 18, 2025, a portable X-Ray was executed and the R1 was diagnosed with an injury at the top of the upper arm bone and a shoulder dislocation. After consulting with an orthopedic doctor, it was decided that a closed reduction could be attempted. (Per Mayo Clinic definition a Closed reduction is a procedure where some gentle maneuvers might help move the shoulder bones back into position.***{CONTINUE 809C***} Depending on the amount of pain and swelling, a muscle relaxant or sedative or, rarely, a general anesthetic might be given before moving the shoulder bones. When the shoulder bones are back in place, severe pain should improve almost immediately.) R1 was given pain medication, and the reduction was performed. A follow-up X-ray was ordered to confirm successful reduction. By February 21, 2025, a repeat X-ray showed that the shoulder was still dislocated. Plans were made to take R1 to an orthopedic clinic the next day. However, on February 22, 2025, R1 was transferred to the hospital by a family member. Medical record from the Hoag Hospital Emergency Center dated February 22, 2025, listed R1’s diagnoses as a dislocation of the left shoulder joint, a closed fracture of the head of the left humerus, and an acute embolism and thrombosis of the deep vein of the left upper extremity. Interviews with four staff conducted during the investigation denied any failure to provide adequate supervision or to initiate a timely medical response following the falls of R1; however, the facility’s Internal Incident Report from February 22, 2025, states that R1 complained of severe left arm pain immediately following the fall. Despite this, facility staff notified hospice instead of contacting 911. Based on the preponderance of evidence, the facility did not provide care and supervision and failed to seek timely medical attention. The facility is being cited for violating Title 22, Division 6 of the California Code of Regulations. An immediate civil penalty was assessed per LIC421IM. A Civil Penalty is pending determination by Community Care Licensing Division as per Health & Safety Code 1569.49. An exit interview was conducted and a copy of this report along with LIC809-D, Appeal Rights, Civil Penalty Assessment -LIC 421 IM and the LIC 811, identifying confidential names were provided.the state’s words, verbatim · CDSS document, Aug 20, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(g) · Plan of correction due date: Aug 20, 2025

87465(g) Incidental Medical and Dental. The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including but not limited to, an apparent life-threatening medical crisis This requirement was not met as evidence by: Licensee did not seek immediate medical attention following R1 sustainingthe state’s words, verbatim · CDSS document, Aug 20, 2025

Plan of correction: Licensee will conduct training to all facility staff on when to call emergency services to residents who are in need of immediate hospitalization and well send traning log to LPA by POC due date an unwitnessed fall on February 12, 2025, despite of persistent pain, developing swelling, bruising and losing the ability to complete ADLs, which poses an immediate risk to resident’s health in care.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87464(f)(1) · Plan of correction due date: Aug 20, 2025

87464(f)(1) Basic Services: Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidenced by: Licensee did not re-evaluate care needs following R1 sustaining eight falls within a five month period resulting in R1 being hospitalized with shoulderthe state’s words, verbatim · CDSS document, Aug 20, 2025

Plan of correction: Licensee will ensure re-evaluate residents and document all updates when incidents of injures and such occurs to ensure the safety od residents in care. and humerus fractures. This poses an immediate risk to resident’s health in care

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87463(b)(1)(E) · Plan of correction due date: Aug 20, 2025

87463(b)(1)(E) The reappraisal shall document significant changes in the resident's physical, mental, cognitive, behavioral, or functional condition, including those required to be documented as specified in Section 87466, Observation of the Resident. This requirement was not met as evidence by: Licensee did not update needs and services plan as required by section above.the state’s words, verbatim · CDSS document, Aug 20, 2025

Plan of correction: Facility will sel-certify the understanding of reappraisals for residents who require an updated Needs& services plan and e mail LPA the by POC due date This poses an immediate risk to resident’s in health care.

Type of visit: Case Management - Health Checks

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 providedthe state’s words, verbatim · CDSS document, Jul 18, 2025

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

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 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.the state’s words, verbatim · CDSS document, Jun 10, 2025 · control 22-AS-20241014143034

Type of visit: Case Management - Health Checks

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.the state’s words, verbatim · CDSS document, May 2, 2025

Type of visit: Case Management - Other

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.the state’s words, verbatim · CDSS document, Apr 21, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced Case Management - Deficiencies visit. LPA arrived at the facility was greeted and granted entry by Administrator (AD) Susan Lee. LPA explained to AD that this visit is in regards to a flagged incident report that the facility had sent over our regional office. According to the incident report, on March 31st 2025, resident from memory care unit eloped the facility at around 2:00pm and returned by the police department at 4:00 pm. The resident was found at a skilled nursing facility that contacted Anaheim Police Department to later find out that the resident eloped from Harbor Heights Assisted Living. This marks the second incident for a memory care resident to have eloped the building in less than 12 months period. It was determined that facility lacked of care and supervision to the resident; with this noted, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. Immediate civil penalties are being assessed. See LIC421IM. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Apr 8, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(e)(5) · Plan of correction due date: Apr 8, 2025

87705(e)(5) Facility staff shall ensure the continued safety of residents if they wander away from the facility....} Based on observation interviews, record review, the licensee did not in sure the safety of the resident who eloped the facility which poses an immediate Health and safety to persons in care.the state’s words, verbatim · CDSS document, Apr 8, 2025

Plan of correction: AD will hire additional staff to primarily cover memory care main exit and maintain count of residents.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Samer Haddadin made an unannounced visit to conduct the required annual inspection. LPA met Executive Director (ED), Susan Lee, and explained the reason for the visit. LPA toured the interior and exterior portions of the facility with staff and observed the following: The facility has a capacity of 199, of which 194 can be non-ambulatory and 5 bedridden. facility has a hospice waiver for 25 residents. Facility phone number 714-459-3353. LPAs observed the following. 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 115 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 as well as staff break room. LPA observed a sitting room with books and places to sit next to the main entrance of the facility. LPA checked memory care building for 6 residents and observed that hot water temperature was between 93.9- and 94.6-degree Fahrenheit. LPA observed all chemicals and shapes are locked and inaccessible to residents in care. All residents had clean linen, furniture, chair and hygiene supplies. Fire extinguishers were observed fully charged and indicator in the green zone with inspection date of March 5th, 2025. LPA checked assisted living building for 6 residents and observed that hot water temperature was between 108.9- and 109.2-degree Fahrenheit. LPA observed all chemicals and shapes are locked and inaccessible to residents in care. All residents had clean linen, furniture, chair and hygiene supplies. Fire extinguishers were observed fully charged and indicator in the green zone with inspection date of March 5th, 2025. LPA checked medication room and observed that all meds are locked and inaccessible to residents in care. All medications are given to residents by a Med-tech. LPA reviewed 12 residents’ files and medications with no discrepancies observed. LPA reviewed 12 electronic staff files and observed all paperwork were up to date. Based on the observations made during today’s inspection, one deficiency is 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 appeal rights provided to ED at end of inspection.the state’s words, verbatim · CDSS document, Mar 27, 2025

Type of visit: Case Management - Health Checks

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.the state’s words, verbatim · CDSS document, Mar 7, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced Case Management - Deficiencies visit. LPA arrived at the facility was greeted and granted entry by Administrator (AD) Susan Lee. LPA explained to AD that this visit is in regards to a flagged incident report that the facility had sent over our regional office on 2/11/2025. The incident report took place on 01/21/2025 stated that at 10:30 AM a dementia resident (R1) had eloped that facility. according to the incident report, the facility called 911 and at 10:50 AM a police helicopter located the resident about 1.2 miles from the facility. LPA interviewed the staff (s1) who was on duty dining the incident, as well as AD. It was determined that facility lacked of care and supervision to the resident. , Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. Immediate civil penalties are being assessed. See LIC421IM. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Feb 21, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(e)(5) · Plan of correction due date: Feb 21, 2025

87705(e)(5) Facility staff shall ensure the continued safety of residents if they wander away from the facility....} Based on observation interviews, record review, the licensee did not in sure the safety of the resident who eloped the facility which poses an immediate Health and safety to persons in care.the state’s words, verbatim · CDSS document, Feb 21, 2025

Plan of correction: AD will retrain staff members and make sure the front Reception is covered and has staff at all times

Type of visit: Case Management - Health Checks

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.the state’s words, verbatim · CDSS document, Jan 3, 2025

Allegation investigated: Staff do not ensure resident's room is kept cleaned.

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegation. LPA met with Administrator (AD) Susan Lee, discussed the purpose of the inspection, and explained the allegation. The investigation into the allegation that staff do not ensure resident's room is kept cleaned revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, residents, and witnesses, and obtained and reviewed copies of the resident roster, staff roster, and staff schedule. CONTINUED Unsubstantiated 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.the state’s words, verbatim · CDSS document, Dec 13, 2024 · control 22-AS-20241210164440

Allegation investigated: Facility staff did not meet resident's needs

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegation. LPA met with Administrator (AD) Susan Lee, discussed the purpose of the inspection, and explained the allegation. The investigation into the allegation that facility staff did not meet resident's needs revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, residents, and witnesses, and obtained and reviewed copies of the resident roster, staff roster, Resident #1’s (R1) Assisted Living Waiver Assessment dated May 16, 2024, and R1’s Assisted Living Waiver Individual Services Plan dated May 16, 2024. CONTINUED Unsubstantiated It was alleged that R1 is often left alone in their room in the dark, their hygiene needs are not yet, they lost significant weight, and are declining rapidly. LPA interviewed a witness who stated there are no major concerns with R1’s hygiene, they do not know if R1 has lost weight since entering the facility, and that R1 has declined rapidly but R1’s decline may be a consequence of their diagnosis. LPA conducted a health and safety check on R1 and LPA’s observations of R1 did not corroborate the allegation. LPA interviewed R1 and did not obtain information corroborating the allegation. LPA conducted health and safety checks on and interviews with 19 additional residents and did not obtain information corroborating the allegation. LPA interviewed AD who denied the allegation, stating that R1 sometimes chooses to be in their room and locks their door, there have been no reports of hygiene issues with R1, that R1 has not lost weight, and that R1’s care needs have increased solely due to mental health concerns and not physical health. LPA reviewed R1’s Assisted Living Waiver Assessment dated May 16, 2024, which states that R1 weighs 115 pounds. During the inspection, LPA observed a staff member weigh R1 and noted R1 currently weighs 128 pounds, which indicates R1 gained weight while at the facility. LPA reviewed R1’s Assisted Living Waiver Individual Services Plan dated May 16, 2024, which indicates R1’s care needs are Tier 2. LPA interviewed R1’s Assisted Living Waiver care coordinator who stated that R1 was reassessed as Tier 4 due to decreasing cognitive ability and now needing redirection with all activities of daily living. No information was obtained showing that R1’s cognitive decline was caused by lack of care and supervision by the facility. 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.the state’s words, verbatim · CDSS document, Dec 13, 2024 · control 22-AS-20241213125846

Type of visit: POC

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.the state’s words, verbatim · CDSS document, Oct 28, 2024

Type of visit: POC

On 10/15/2024, 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 8/20/2024 and 8/29/2024, LPA Mason issued a deficiency 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. 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). They shall be kept clean and food stored to LPA toured the kitchen and made the following observations: LPA observed the two-burner stove to be in the same position. ED stated they moved the food preparation station across from the 2-burner stove in order to make more room for staff to pass through. LPA determined the plan of correction utilized is not what was agreed upon. A citation is being issued. LPA observed the refrigerator temperature to be set between 42-43 degrees F and the freezer temperature to be set to -10 degrees F. Based on today's inspection, two citation are. An exit interview was conducted and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 15, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(21) · Plan of correction due date: Oct 23, 2024

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). They shall be kept clean and food stored to enable adequate air circulation to maintain the above temperatures. Based on observations, the Licensee did not comply with the regulation cited above due to the refrigerator temperature being set between 42-43 degrees F. This creates a potential health risk to persons in care.the state’s words, verbatim · CDSS document, Oct 15, 2024

Plan of correction: Executive Director stated they will create a log to document the refrigerator temperatures. ED also stated they will continue trying to work with maintenance to get the refrigerator temperature below 40 degrees F. LPA will verify the plan of correction via plan of corrections visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87555(b)(20) · Plan of correction due date: Oct 23, 2024

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. Based on observations, the Licensee did not comply with the section cited above due to a 2-burner stove in the kitchen protruding 17.5 inches into the aisle where kitchen staff work and move.the state’s words, verbatim · CDSS document, Oct 15, 2024

Plan of correction: Executive Director stated they will replace the two-burner stove in the facility with a single-burner stove by the assigned POC due date. LPA will verify the correction at a plan of corrections visit.

Allegation investigated: Facility is not ensuring the facility is kept at a comfortable temperature. Food portions are insufficient for the residents' nutritional needs Facility is not sufficiently staffed for residents with special needs

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on the investigation into the three allegations listed above. LPA was greeted and granted entry by facility staff after introducing himself and explaining the purpose of the visit. Executive Director Susan Lee was present and assisted with the visit after being presented with the allegations. The initial complaint investigation visit was conducted on June 20, 2024. During the visit, LPA requested and obtained the facility's resident census, room assignments and Resident Care schedule for June 2024. LPA accompanied by facility staff conducted a tour of the physical plant. Staff and resident interviews were conducted during the visit. During the follow up visit, LPA toured the premises again. Temperatures were measured in common areas, hallways and a total of thirteen shared units. Five resident interviews were attempted or conducted. September schedule and records of employee clock-ins were requested and obtained. CONTINUED ON FORM LIC9099-C Unsubstantiated 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.the state’s words, verbatim · CDSS document, Sep 9, 2024 · control 22-AS-20240618165757

Allegation investigated: Facility does not provide hygiene items for residents The facility does not provide food in the quantity necessary to meet the needs of the residents Facility is not providing activities for residents

This unannounced investigation inspection by Licensing Program Analyst (LPA) Dwayne Mason Jr. is being conducted to conclude this agency’s investigation in the complaint allegation(s) mentioned above. LPA arrived at the facility and was greeted by reception staff. LPA met with Susan Lee, Executive Director and explained the nature of the inspection. The department received a complaint on 6/10/2024 stating facility does not provide hygiene items for residents, facility does not provide food in the quantity necessary to meet the needs of the residents and facility is not providing activities for residents. During the investigation, the department interviewed Executive Director (ED), staff and residents in care. (continued on LIC9099-C) Unsubstantiated (continued from LIC9099) On 6/14/2024 LPA obtained copies of the Personnel roster, Resident roster date 6/11/2024, the activity calendar and menu for the month of June, activity program description, food service policy and incontinence care plan. LPA conducted interviews with Executive Director, staff and residents in care. In regards to the allegation of facility does not provide hygiene items for residents, LPA conducted interviews with Executive Director, staff and residents in care. LPA conducted interviews with Executive Director (ED). ED stated facility provides blue pads to any residents who are incontinent in Assisted Living (AL) and Memory Care (MC). ED stated facility provides hygiene supplies to all residents in Memory Care. ED stated that the facility does not sell wipes to residents. LPA conducted interviews with Caregivers (C1, C2, C3, C4, C5). All caregivers stated the facility provides blue pads and hygiene supplies residents in memory care and other incontinent residents. C2 stated the facility stopped supplying wipes to the entire facility in June. Other caregivers stated they were not sure if the entire facility receives wipes. LPA conducted interviews with Residents who were identified as receiving incontinence care (R9-R19). No disclosures were made regarding the allegation from the eleven residents interviewed with regards to hygiene supplies for incontinence. In regards to the allegation of facility does not provide food in the quantity necessary to meet the needs of the residents. LPA toured the kitchen and dining area during meal times on 8/20/2024 and 8/22/2024. LPA conducted interviews with Kitchen Staff (K1, K2, K3, K4, K5). All kitchen staff stated, the facility provides residents with additional helpings of food upon request. Kitchen staff stated snacks are offered three times a day at 10:30am 2:30pm and 6:30pm. Kitchen staff stated snacks offered in the dining area or on the 2nd and 3rd floor activity area. LPA also observed meals and snacks being delivered to resident rooms. LPA obtained photo of a tray of snacks from the 2nd floor of the facility that residents had already gotten snacks from. LPA observed tray to have crackers, chips, bananas, applesauce and granola bars. LPA conducted interviews with Residents (R1, R2, R3, R4, R5, R6, R7 and R8). Based on interviews, R1, R2, R3, R4, R6 and R8 stated that meal portions are fine. All residents stated they are able to get additional helpings of food if they want. R1, R2, R3, R4, and R6 stated there are snacks at the facility three times a day. In regards to the allegation of facility is not providing activities to residents, LPA interviewed Activity Staff (A1, A2, A3, A4, A5). A1 and A3 stated A1 is Activities Director working part time until September. (continued on LIC9099-C) (continued from LIC9099-C) A1 and A3 stated A3 is the full-time activities staff currently. LPA verified A3’s full-time status via August 2024 staff schedule. LPA observed activities taking place on 8/20/2024 and 8/22/2024. On 8/20/2024, LPA obtained photos of two Activity Assistants leading a group of 11 residents in seated stretches during the scheduled ‘Exercises & Bingo Game’ activity in the dining room. On 8/22/2024, LPA obtained photos of the Activities Director leading a group of 8 Memory Care residents in the scheduled ‘Bingo’ activity in the 2nd floor activity room. LPA observed both activities during the corresponding time and date on the activities calendar. LPA interviewed residents (R1, R2, R3, R4, R5, R6, R7 ,R8) regarding activities. Based on interviews conducted, R1, R2, R5, R6, R7 and R8 participate in activities and state there are enough activities and facility staff encourage residents daily to participate. Regarding the allegation of facility does not provided hygiene items for residents, LPA reviewed records and conducted interviews with staff and residents. LPA observed staff administering incontinence care with blue pads and wipes. LPA observed blue pads and wipes stored in the MedTech room. Based on interviews conducted and records obtained, LPA determined facility is providing hygiene supplies to residents. Regarding the allegation of facility does not provide food in the quantity necessary to meet the needs of the residents, LPA determined six out of eight residents interviewed do not think portions are an issue. LPA observed five different meal options between two different meal times and observed food to be appropriately portioned. Based on all resident interviews, additional servings are available upon request. Five out of eight residents interviewed stated snacks are provided three times a day. LPA observed snacks offered in dining room, kitchen and on the 2nd floor activity area. Based on observations and interviews conducted, LPA determined the facility does provide food in the quantity necessary to meet the needs of the residents. Regarding the allegation of facility is not providing activities for residents, LPA interviewed staff and residents. Based on observations and interviews conducted, LPA determined the facility is providing activities for residents. Based on interviews conducted, observations made and records reviewed there is insufficient evidence to support the above allegation(s). Although the allegation(s) may have happened or are valid; there is not a preponderance of evidence to prove that the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted, and this report was reviewed with Executive Director, Susan Lee. A copy of this LIC-9099 was provided to the facility.the state’s words, verbatim · CDSS document, Sep 9, 2024 · control 22-AS-20240610144900

Allegation investigated: Staff refused to assist resident

Licensing Program Analyst (LPA) Ruth Martinez visited the facility to deliver findings for the investigation into the above identified complaint allegation. LPA arrive at facility was greeted and granted entry by staff. LPA met with Susan Lee, Executive Director and explained the nature of the visit. Findings are based upon this investigation which included resident file review, tour of the physical plant of the facility and interviews conducted. It is alleged staff refused to assist resident, details of the complaint states two staff members. In review of staff schedule for caregiver it does not reflect any caregivers with names mentioned in the complaint detail submitted. Upon review it was indicated that staff mentioned in complaint details were a facility nurse and the Continued on LIC9099-C Unsubstantiated resident care coordinator which are no longer employed at the facility. Interview with 8 of 8 residents stated that they get the assistance that they need, and they have no issues getting help. Interview with a witness stated that resident gets the help they need and that they are notified immediately upon any issues that resident may have. Interview with 4 of 4 facility staff stated that residents request help and caregivers/staff provide the care requested. Staff stated that they have not received a complaint or concern from any residents indicating they didn't get the help they requested. Staff stated that resident (R1) gets the help they need, but no matter what R1 always complains for one reason or another. R1 tends to get agitated a lot if things aren't done how they want them to be done or at the time frame they want them to be done. Staff stated that maybe residents diagnosis plays a role in their behavior, but none the less all residents get the assistance that they need. Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegations 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 with facility representative and a copy of this LIC9099 report was left at facility.the state’s words, verbatim · CDSS document, Sep 9, 2024 · control 22-AS-20240626135527

Allegation investigated: Facility has trip hazards in the dining room and kitchen. Facility is not maintained at a comfortable temperature for residents in care.

This unannounced investigation inspection by Licensing Program Analyst (LPA) Dwayne Mason Jr. is being conducted to conclude this agency’s investigation in the complaint allegation(s) mentioned above. LPA arrived at the facility and met with Susan Lee, Executive Director and explained the nature of the inspection. The department received a complaint on 6/10/2024 stating facility has trip hazards in the dining room and kitchen and that facility is not maintained at a comfortable temperature for residents in care. During the investigation, the department interviewed Executive Director (ED), staff and residents in care. On 6/14/2024 LPA conducted a visit to the facility. In regards to the allegation of facility has trip hazards in the dining room and kitchen, LPA toured the facility and observed an aisle in the kitchen between appliances and food storage. Facility staff occupy this aisle while preparing food. (continued on LIC9099-C) Unsubstantiated (continued from LIC9099) On 6/14/2024 LPA conducted a visit to the facility. LPA obtained copies of: resident roster dated 6/11/2024, menu for the month of June and facility food service policy. LPA toured the facility and interviewed staff and residents in care. Staff and Residents made no disclosures regarding the allegation. Staff stated the facility always adheres to regulations regarding food storage and preparation. On 8/20/2024, LPA returned to the facility. LPA obtained copies of the facility’s 8/19/2024 invoice for U.S. Food and the receipts for the grocery store. In regards to the allegation of facility does not store food properly, LPA observed food to be improperly stored in the facility kitchen. LPA observed kim chi, broccoli and rice stored in uncovered in buckets without lids in the refrigerator. LPA observed metal containers with beef partially covered with plastic. LPA observed slices of cheesecake stored in the refrigerator uncovered. Per regulation, all readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. LPA observed refrigerator temperature to be 46.8 degrees Fahrenheit. LPA observed freezer temperature to be -8 degrees Fahrenheit. Per regulation, 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). They shall be kept clean and food stored to enable adequate air circulation to maintain the above temperatures. LPA conducted interview with ED. ED stated the facility has contract with U.S. Food (USF). LPA conducted interviews with Staff and Residents. Staff and Residents stated they have not seen or heard of any other residents or staff falling or tripping in the dining room or kitchen. During the investigation, there was sufficient evidence to substantiate the allegation of facility does not store food properly. Based on observations made and photos obtained, the preponderance of evidence standard has been met; therefore, the above allegation is SUBSTANTIATED. See LIC9099-D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations An exit interview was conducted, and this report was reviewed with ED. A copy of this LIC-9099 was provided to the facility. (continued from LIC9099) LPA measured aisle to be 43.5 inches wide. LPA observed a two-burner stove that extends into the aisle by 17.5 inches. LPA measured the distance from the front face of the two-burner oven to the shelf of food across from it. The aisle measured 26 inches. LPA conducted interviews with residents in care who stated that they do not enter the kitchen as it is an off-limits area to them. Residents also stated they have never seen or heard about tripping or falling in the dining room or kitchen. LPA also interviewed kitchen staff. Kitchen staff stated they have not tripped or heard of any staff report that they tripped in the kitchen. Kitchen staff stated that they have not heard of any staff or resident tripping in the dining room. Kitchen staff stated they feel like they have enough room to safely navigate the aisle. In regards to the allegation of facility is not maintained at a comfortable temperature for residents, LPA interviewed staff and residents in care. LPA observed three thermostats in the facility. The first floor thermostat is located between rooms A105 and A107 and was observed at 74 degrees Fahrenheit. The second floor thermostat is located between rooms A213 and A215 and was observed at 76 degrees Fahrenheit. The third floor thermostat is located between rooms A317 and A315 and was observed at 77 degrees Fahrenheit. During interviews conducted, six of the seven residents interviewed stated the temperature in the facility is comfortable. All staff interviewed stated the temperature in the facility is comfortable. All staff interviewed stated the temperature in the facility is comfortable. LPA obtained photos of the thermostats throughout the facility. LPA obtained copies of the following files: resident roster dated 6/11/2024, personnel contact list and facility floor plan. Based on record review and interviews conducted with ED, staff and residents, LPA determined that the facility does not have tripping hazards in the dining room and the facility is maintained at a comfortable temperature for residents. Based on interviews conducted and records reviewed there is insufficient evidence to support the allegations. Although the allegations may have happened or are valid; there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted, and this report was reviewed with ED. A copy of this LIC-9099 was provided to the facility.the state’s words, verbatim · CDSS document, Aug 29, 2024 · control 22-AS-20240610155726

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(21) · Plan of correction due date: Sep 12, 2024

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). They shall be kept clean and food stored to enable adequate air circulation to maintain the above temperatures. Based on observations, the Licensee did not comply with the regulation cited above due to the refrigerator temperature being set to 46.8 degrees F. This creates a potential health risk to persons in care.the state’s words, verbatim · CDSS document, Aug 29, 2024

Plan of correction: Executive Director stated they will have kitchen staff adjust refrigerator temperature. LPA will verify the plan of correction via plan of corrections visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(23) · Plan of correction due date: Sep 12, 2024

87555 General Food Service Requirements (23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. Based on observations, the Licensee did compy with the regulation cited above due to LPA observations of five perishable foods being uncovered in the kitchen.the state’s words, verbatim · CDSS document, Aug 29, 2024

Plan of correction: Executive Director stated they will work with the kitchen staff to continually store food properly according to Title 22 Regulations and hold an in-service training on food storage and preparation. ED stated they will email LPA documentation reflecting the training.

Type of visit: Case Management - Deficiencies

On 8/20/2024, LPA Dwayne Mason Jr. conducted a Case Management visit to the facility. LPA arrived and was greeted and granted entry by Executive Director Susan Lee. LPA explained the nature of the inspection. LPA toured the facility and observed an aisle in the kitchen between appliances and food storage. Facility staff occupy this aisle while preparing food. LPA measured aisle to be 43.5 inches wide. LPA observed a two-burner stove that extends into the aisle by 17.5 inches. LPA measured the distance from the front face of the two-burner oven to the shelf of food across from it. The aisle measured 26 inches. LPA obtained photos. Based on observations, one citation is being issued. An exit interview was conducted and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Aug 20, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(20) · Plan of correction due date: Sep 10, 2024

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. Based on observations, the Licensee did not comply with the section cited above due to a 2-burner stove in the kitchen protruding 17.5 inches into the aisle where kitchen staff work and move.the state’s words, verbatim · CDSS document, Aug 20, 2024

Plan of correction: Executive Director stated they will move or remove the two-burner stove from the facility by the assigned POC due date. LPA will verify the correction at a plan of corrections visit.

Allegation investigated: Staff does not ensure medications are properly managed for residents in care

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility and interviewed staff and residents as well as reviewed and obtained pertinent documentation such as medication administration record. Regarding the allegation that Staff does not ensure medications are properly managed for residents in care, the investigation revealed the following: Resident I (R1) is prescribed Oxycodone-Acetaminophen 5-325 (Percoset 5-325) three times daily. Facility documentation indicates reaching out to physician and pharmacy on three different occasions, 06/08, 06/10 and 06/11/2024 to obtain a refill for the medication. Resident missed three doses, evening dose on 06/13/2024 and morning/ afternoon dose on 06/14/2024. Medication review indicates a new pack was started on 06/14/2024. Facility staff indicate usual pharmacy changed operation by acquiring another pharmacy in June 2024 and did not notify facility timely. Based on interview and record review, CONTINUED ON LIC 9099C DATED 06/19/2024 Unsubstantiated 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.the state’s words, verbatim · CDSS document, Jun 19, 2024 · control 22-AS-20240614132753

Allegation investigated: Facility does not have a qualified Administrator

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA met with Assistant Administrator Yaylene Mazariegos and explained the reason for the visit. The investigation revealed the following. It was alleged that the facility does not have an Administrator who has a current Administrator's certificate. The former Administrator stopped working for the facility on May 3, 2024. LPA verified this information with the former Administrator. The Licensing Program Analyst assigned to the facility did not receive a new LIC 308, designation of facility responsibility, along with the prospective Administrator's valid certificate, naming the new Administrator. LPA interviewed 2 facility staff who verified the facility does not have an Administrator who has a current Administrator's certificate. No information was provided to the Agency regarding a new Administrator. From May 4, 2024 to the date of this report, May 15, 2024 the facility does not have a currently certified Administrator. Based on the information gathered the preponderance of evidence standard has been met, therefore, the allegation, is deemed substantiated. Substantiated Violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report along with citation and Appeal Rights was provided.the state’s words, verbatim · CDSS document, May 15, 2024 · control 22-AS-20240509144506

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(a) · Plan of correction due date: May 24, 2024

87405(a)Administrator - Qualifications and Duties:(a)All facilities shall have a qualified and currently certified administrator... This requirement is not being met as evidenced by, through a record review and interviews it was demonstrated that the facility does not a qualified and currently certified administrator. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 15, 2024

Plan of correction: Licensee agrees to hire a qualified and currently certified administrator and to submit the required documentation for the new administrator to the LPA by the POC due date.

Type of visit: Prelicensing

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. 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. 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.the state’s words, verbatim · CDSS document, Apr 22, 2024

Type of visit: Office

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 readinessthe state’s words, verbatim · CDSS document, Feb 28, 2024