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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004192
Report Date: 03/04/2024
Date Signed: 03/04/2024 06:07:06 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/05/2023 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20231205121033
FACILITY NAME:WHITTEN HEIGHTS ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
306004192
ADMINISTRATOR:STEVE SHENFACILITY TYPE:
740
ADDRESS:200 WEST WHITTIER BLVD.TELEPHONE:
(562) 691-1200
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:196CENSUS: 116DATE:
03/04/2024
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Steve ShenTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Resident sustained a bruise to the left arm while being assisted.
Facility did not accommodate a new caregiver per the family's request.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings of the investigation into the allegations listed above. LPA met with Administrator Steve Shen and explained the reason for the visit. The investigation into the allegation, resident sustained a bruise to the left arm while being assisted revealed the following. Resident 1 (R1) reported that they bruised their arm because of the bed rail on their bed. R1 reported that sometimes they put their arm over the bed rail and it causes bruising. Staff reported they do not handle R1 in a rough manner and did not do anything to cause R1 to be bruised. R1 verified this report. Resident did get bruised while at the facility but it was not caused by staff. None of the evidence gathered supports the allegation, therefore the allegation is unfounded, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.

The investigation into the allegation, facility did not accommodate a new caregiver per the family's request, revealed the following. It was alleged that family of R1 requested a new caregiver that could better meet the needs of R1 but the facility refused to accommodate this request.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/05/2023 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20231205121033

FACILITY NAME:WHITTEN HEIGHTS ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
306004192
ADMINISTRATOR:STEVE SHENFACILITY TYPE:
740
ADDRESS:200 WEST WHITTIER BLVD.TELEPHONE:
(562) 691-1200
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:196CENSUS: 116DATE:
03/04/2024
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Steve ShenTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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9
Facility staff disrespected residents and their families by wearing offensive clothing.
Resident's representative was not informed of the bruise.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings of the investigation into the allegations listed above. LPA met with Administrator Steve Shen and explained the reason for the visit. The investigation into the allegation, facility staff disrespected residents and their families by wearing offensive clothing revealed the following. It was alleged that a staff member wore an offensive sweatshirt "hoodie" that said, "F - U" on it. The Administrator and staff interviewed verified this report. The Administrator reported that the staff member was told to never wear that item again. None of the witnesses interviewed could agree on how long the staff member wore the sweatshirt. All witnesses interviewed agreed the staff member did wear the sweatshirt on the morning of December 3, 2023. The preponderance of evidence standard has been met, therefore, the allegation, is found to be SUBSTANTIATED.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 22-AS-20231205121033
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: WHITTEN HEIGHTS ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 306004192
VISIT DATE: 03/04/2024
NARRATIVE
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Regarding the allegation, resident's representative was not informed of the bruise, the investigation revealed the following. It was reported that R1 sustained a bruise sometime in November or December 2023. 5 out of 5 staff interviewed reported seeing R1 with a bruise on their left arm but do not know when R1 got the bruise. 5 out of 5 staff reported that they remember seeing R1 with a bruise on their left arm in December 2023. 5 out of 5 staff reported that they did not report the bruise to anyone. R1 reported they did not remember when they sustained the bruise but reported they got it from the bed rail. A review of facility records and Agency records shows no incident report was sent regarding R1’s bruise. R1's responsible party reported they saw the bruise in December and it was not reported to them by facility staff. The facility could not provide any documentation that the bruise was reported to the responsible party. The preponderance of evidence standard has been met, therefore, the allegation, is found to be 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.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 22-AS-20231205121033
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: WHITTEN HEIGHTS ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 306004192
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/14/2024
Section Cited
CCR
87468.1(a)(1)
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To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by;
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Licensee agrees to train staff on personal rights of all residents CCR 87468.1 and to instruct all staff not to wear offensive clothing while working. Licensee to submit proof of training to LPA by POC due date.
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On December 3, 2023 facility staff wore a sweatshirt "hoodie" that said, "F - U" on it. This poses a potential health and safety risk to residents in care.
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Type B
03/14/2024
Section Cited
CCR
87466
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The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes... or a physical health condition are observed, the licensee shall ensure that
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Licensee agrees to train facility staff on all reporting requirements CCR 87211 and the proper observation of residents CCR 87466 and to submit proof of training to LPA by POC due date.
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such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement was not met as evidenced by, the facility did not notify R1's responsible party of the bruise on their right arm. This poses a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/05/2023 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20231205121033

FACILITY NAME:WHITTEN HEIGHTS ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
306004192
ADMINISTRATOR:STEVE SHENFACILITY TYPE:
740
ADDRESS:200 WEST WHITTIER BLVD.TELEPHONE:
(562) 691-1200
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:196CENSUS: 116DATE:
03/04/2024
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Steve ShenTIME COMPLETED:
06:00 PM
ALLEGATION(S):
1
2
3
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5
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9
Facility smells like cigarettes.
Facility staff does not communicate properly with resident due to language barriers.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings of the investigation into the allegations listed above. LPA met with Administrator Steve Shen and explained the reason for the visit. The investigation into the allegation, facility smells like cigarettes, revealed the following. LPA toured the facility with the Administrator. It was reported that the second-floor smells like cigarettes. During the 10-day visit on 12/11/23 and the visit on 3/4/24 LPA toured the facility and only smelled cigarette smoke outside in the smoking section of the facility. Staff interviewed that some of the residents like to smoke, and they smoke outside in the patio which is the smoking section of the facility. LPA did not observe anyone smoking in the facility and did not smell any smoke in the facility. Based on the evidence gathered through observation and interviews the allegation is unsubstantiated, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 22-AS-20231205121033
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: WHITTEN HEIGHTS ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 306004192
VISIT DATE: 03/04/2024
NARRATIVE
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Regarding the allegation, facility staff does not communicate properly with resident due to language barriers, the investigation revealed the following. It was reported that on December 3, 2023, staff ignored resident’s request to have the TV turned off because of a language barrier between the staff and residents. 5 out of 5 staff interviewed denied this report. None of the staff interviewed recall being asked to turn of a TV on December 3, 2023. R1 reported they do not remember the incident. 4 out of 4 residents interviewed reported they had no language issues with staff. Based on the information gathered through interviews the allegation is unsubstantiated, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted and a copy of the report provided.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 22-AS-20231205121033
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: WHITTEN HEIGHTS ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 306004192
VISIT DATE: 03/04/2024
NARRATIVE
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The Administrator and staff interviewed reported that after the request was made Staff 1 (S1) was assigned to a different area and Staff 2 (S2) replaced S1 in assisting R1. Both S1 and S2 verified this report. R1 verified this report. None of the evidence gathered supports the allegation, therefore the allegation is unfounded, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 7