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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006452
Report Date: 03/20/2026
Date Signed: 03/22/2026 04:32:09 PM

Unsubstantiated


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
02/11/2026 and conducted by Evaluator Samer Haddadin
COMPLAINT CONTROL NUMBER: 22-AS-20260211155055
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:
03/20/2026
UNANNOUNCEDTIME BEGAN:
12:39 PM
MET WITH:Case Manager-April PenaTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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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.
INVESTIGATION FINDINGS:
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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
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2026
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 3
Control Number 22-AS-20260211155055
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: 03/20/2026
NARRATIVE
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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***)
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20260211155055
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: 03/20/2026
NARRATIVE
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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.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3