306002853-5-27-2026-22-AS-KSGH-DUMTA6-20260601143302

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002853
Report Date: 05/18/2026
Date Signed: 05/27/2026 08:05:13 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
05/13/2026 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20260513084703

FACILITY NAME:	HUNTINGTON ELDER-CARE II		FACILITY NUMBER:	306002853
ADMINISTRATOR:	CARMEN G. ACHIM		FACILITY TYPE:	740
ADDRESS:	9452 NAUTILUS DRIVE		TELEPHONE:	(714) 378-0563
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92646
CAPACITY:	6	CENSUS: 6	DATE:	05/18/2026
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Carmen Achim		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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9

Staff is not allowing resident to be readmitted to facility
Staff did not ensure reporting requirements were followed
Staff did not ensure a needs assessment evaluation was conducted for resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Ruth Martinez and Nancy Guillen conducted an unannounced visit to the facility to investigation the above identified complaint allegations and delivered findings. LPAs arrived at facility and were greeted at the door and granted entry by caregiver. LPAs spoke with Carmen Achim, Administrator, and explained the purpose of the visit.

After further investigation into this complaint and information received LPAs determined that this complaint was written under the wrong facility license number. LPA’s investigation determined that resident (R1) has never resided at this facility. We have found the complaint allegations are unfounded, meaning that the allegations are false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted with Administrator and a copy of this LIC9099 report was left at facility.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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