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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004796
Report Date: 10/01/2024
Date Signed: 10/01/2024 03:00:44 PM


Document Has Been Signed on 10/01/2024 03:00 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY:185CENSUS: 160DATE:
10/01/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Business Office Manager, Timarie MorrisseyTIME COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced case management visit to Huntington Terrace. LPA was greeted, granted entry, and explained the reason for the visit. LPA met with Business Office Manager Timarie Morrisey.

The purpose of today's visit was to conduct a Case Management visit to discuss self reported incident that was sent to the Orange County Adult and Senior Care Regional Office on September 30, 2024 and to gather information and documents.

On today's visit LPA Tirre discussed the incident regarding Resident 1 (R1) with Business Office Manager Timarie Morrisey. LPA Tirre obtained records related to incident such as bank statements, copy of deposit, facility staff roster, facility resident roster, and Resident physicians report.

LPA conducted interviews with Business Office Manager and R1.

No deficiencies observed during visit.

A exit interview was conducted with staff representative and a copy of report was provided.

SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) 703-2870
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:
DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/01/2024
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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