<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006452
Report Date: 01/02/2026
Date Signed: 01/02/2026 04:20:22 PM

Substantiated


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
11/21/2025 and conducted by Evaluator Samer Haddadin
COMPLAINT CONTROL NUMBER: 22-AS-20251121155401
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:
01/02/2026
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Sammy LeeTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff is not providing mandated one-on-one supervision to residents on the Resident Habilitative Program
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2026
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 5
Control Number 22-AS-20251121155401
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: 01/02/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 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.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20251121155401
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/02/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/05/2026
Section Cited
CCR
87411(a)
1
2
3
4
5
6
7
 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,
1
2
3
4
5
6
7
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.
8
9
10
11
12
13
14
 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 care
8
9
10
11
12
13
14
Type B
01/09/2026
Section Cited
CCR
87463(b)
1
2
3
4
5
6
7
87463(b)"reappraisal shall document changes in the resident's physical, mental, cognitive, behavioral, or functional condition,as specified in Section 87466"
1
2
3
4
5
6
7
Licensee to update reappraisal documents for residents and send proof to LPA by POC due date
8
9
10
11
12
13
14
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 care
8
9
10
11
12
13
14
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: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
11/21/2025 and conducted by Evaluator Samer Haddadin
COMPLAINT CONTROL NUMBER: 22-AS-20251121155401

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: DATE:
01/02/2026
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:TIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff is not ensuring residents bathing needs are being met
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility to deliver the Department’s findings regarding the above-mentioned allegation. Upon arrival, LPA Haddadin met with Sammy Lee, Administrator Assistant, and explained the purpose of the visit. During the investigation, LPA Haddadin completed a facility walk-through, reviewed facility records, obtained and reviewed relevant documents, and conducted six interviews. It was alleged that “Staff is not ensuring residents’ bathing needs are being met.” LPA Haddadin conducted three staff interviews and three resident interviews. All individuals interviewed denied the allegation. During the facility walk-through, LPA Haddadin did not detect any incontinence odor from the residents interviewed. In addition, LPA Haddadin reviewed the facility’s “Shower Body Check Form,” which reflected that residents requiring assistance with bathing were scheduled to bathe twice per week, including residents enrolled in the Resident Habilitative (RH) Program.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20251121155401
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: 01/02/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5