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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006452
Report Date: 09/11/2025
Date Signed: 09/12/2025 08:55:57 AM

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
09/03/2025 and conducted by Evaluator Samer Haddadin
COMPLAINT CONTROL NUMBER: 22-AS-20250903093211
FACILITY NAME:HARBOR HEIGHTS ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
306006452
ADMINISTRATOR:DUSUN LEEFACILITY TYPE:
740
ADDRESS:525 W. LA PALMA AVETELEPHONE:
(714) 459-3353
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:199CENSUS: 194DATE:
09/11/2025
UNANNOUNCEDTIME BEGAN:
12:32 PM
MET WITH:Susan leeTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Facility mismanaged Resident's medication
Facility failed to report incident to the department
INVESTIGATION FINDINGS:
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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
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
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 2
Control Number 22-AS-20250903093211
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: HARBOR HEIGHTS ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 306006452
VISIT DATE: 09/11/2025
NARRATIVE
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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.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2