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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004796
Report Date: 09/15/2026
Date Signed: 09/15/2026 11:35:04 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/18/2026 and conducted by Evaluator Andrea Mendivil
COMPLAINT CONTROL NUMBER: 22-AS-20260518142118
FACILITY NAME:HUNTINGTON TERRACEFACILITY NUMBER:
306004796
ADMINISTRATOR:EMILY TURNERFACILITY TYPE:
740
ADDRESS:18800 FLORIDA STTELEPHONE:
(714) 848-8811
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY:185CENSUS: 167DATE:
09/15/2026
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Emily Turner - Executive Director TIME COMPLETED:
11:45 AM
ALLEGATION(S):
1
2
3
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5
6
7
8
9
Staff is not allowing resident to be readmitted to facility.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit.

The Department received the complaint on May 18th, 2026 and the initial visit was conducted on May 26, 2026. LPA Mendivil interviewed staff and a witness as well as obtained copies of pertinent documents Resident 1 (R1) LIC 602 Physicians Report, Assessments/Needs and Service Plan, physician's communications,notes &incident documentation and admission agreement. Regarding the allegation staff is not allowing resident to be readmitted to facility, the investigation revealed the following:

It was alleged that staff is not allowing resident to be readmitted to facility. The Department received an Unsual Incident/Injury Report on May 5, 2026 for an incident that occurred on May 2, 2026.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026
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 4
Control Number 22-AS-20260518142118
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: HUNTINGTON TERRACE
FACILITY NUMBER: 306004796
VISIT DATE: 09/15/2026
NARRATIVE
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It was reported that Resident 1 (R1) became physically aggressive and put their hands on a staff's neck. It was reported that the staff was able to leave the room and another staff called 911. R1 was taken to the hospital and placed on a 51/50 hold due to altered mental status. It was then reported by Ruby Gomez, Health Service Director that she conducted a reassessment on May 04, 2026. Due to the incident Executive Director Emily Turner had a call on May 8, 2026 with R1's family and advised that R1 would need a 1:1 caregiver or would potentially need a higher level of care. Three out of three staff interviewed stated that did not tell R1's responsible party that R1 was not allowed back into the facility. Executive Director stated that the family opted to move out R1 and his items were removed on June 3rd, 2026.

Therefore based on the preponderance of evidence through records reviewed and interviews conducted the allegation Staff is not allowing resident to be readmitted to facility is determined to be UNSUBSTANTIATED meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted and a copy of the report was left with the facility representative.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/18/2026 and conducted by Evaluator Andrea Mendivil
COMPLAINT CONTROL NUMBER: 22-AS-20260518142118

FACILITY NAME:HUNTINGTON TERRACEFACILITY NUMBER:
306004796
ADMINISTRATOR:EMILY TURNERFACILITY TYPE:
740
ADDRESS:18800 FLORIDA STTELEPHONE:
(714) 848-8811
CITY:HUNTINGTON BEACHSTATE:CAZIP CODE:
92648
CAPACITY:185CENSUS: 167DATE:
09/15/2026
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Emily Turner - Executive Director TIME COMPLETED:
11:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure reporting requirements were followed.
Staff did not ensure a needs assessment evaluation was conducted for resident in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the faciltiy and explained the reason for the visit.

The Department received the complaint on May 18th, 2026 and the initial visit was conducted on May 26, 2026. LPA Mendivil interviewed staff and a witness as well as obtained copies of pertinent documents Resident 1 (R1) LIC 602 Physicians Report, Assessments/Needs and Service Plan, physician's communications,notes &incident documentation and admission agreement. Regarding the allegations staff did not ensure reporting requirements were followed and staff did not ensure a needs assessment evaluation was conducted for resident in care, the investigation revealed the following:

The Department received an Unsual Incident/Injury Report (LIC 624) on May 5, 2026 for an incident that occurred on May 2, 2026 with Resident 1 (R1). Per LIC 624 R1's responsible party was notified of the incident.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 22-AS-20260518142118
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: HUNTINGTON TERRACE
FACILITY NUMBER: 306004796
VISIT DATE: 09/15/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
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16
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Per review of Notes&Incidents --- Resident Summary a noted added on May 4, 2026 it was noted that Ruby Gomez, Health Service Director conducted an evaluation which was later documented via updated Resident Assessment for R1 on May 21, 2026.

Therefore based on the preponderance of evidence through records reviewed and interviews the allegations Staff did not ensure reporting requirements were followed and Staff did not ensure a needs assessment evaluation was conducted for resident in care were determined to be UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4