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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004796
Report Date: 07/23/2021
Date Signed: 07/23/2021 11:52:05 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:HUNTINGTON TERRACEFACILITY NUMBER:
306004796
ADMINISTRATOR:GREGORY CASEFACILITY TYPE:
740
ADDRESS:18800 FLORIDA STTELEPHONE:
(714) 848-8811
CITY:HUNTING BEACHSTATE: CAZIP CODE:
92648
CAPACITY:185CENSUS: 132DATE:
07/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Executive Director, Greg CaseTIME COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted, granted entry into the facility and temperature was checked at Facility by Accushield device upon check in at front desk. LPA explained reason for visit.

During the visit LPA toured the facility with Administrator Greg Case. Facility is a three story 155 private room facility. There are 132 Residents in care. LPA observed proper covid signage at front entrance of facility. At front receptionist desk there is a check in and temperature Accushield monitor for staff and visitors. Facility has required Department postings.
LPA toured Facility dining room, kitchen, Memory Care, Assisted living, private casidas, outside patios, and medication room. All Resident rooms observed where within department regulations. All restrooms observed contained soap, toilet paper, and towels. Residents were observed relaxing in the dining room eating breakfast, relaxing in lobby area as well as relaxing in bedrooms. Memory care residents were observed relaxing in group activities. Facility has operating smoke detectors and audible alarms which LPA observed Last fire inspection paperwork was completed in April 2021.Facility also uses Waunder guard devices for Memory care residents. Facility has several fire extinguishers, all which were observed as fully charged. Facility has ample supply of PPE. Facility has a large walk in refrigerator and freezer with ample food supply. Kitchen has a large pantry of dry foods with labeled expiration dates. LPA observed facility has emergency food and water supply. Facility has a secured location for resident medication and files. LPA observed 6 residents medications and facility has 30 days supply of medications for Residents. LPA reviewed Residents files during visit. Residents emergency contact information and Physicians reports are current. Facility has several designated visitation areas.

No deficiencies noted during todays visit. An exit interview was conducted with Administrator Greg Case and a copy of report was left at facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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