306004796-12-13-2023-22-AS-AORZ-CYPLV5-20231220080454

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004796
Report Date: 12/13/2023
Date Signed: 12/13/2023 11:53:14 AM

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
12/16/2020 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20201216092545

FACILITY NAME:	HUNTINGTON TERRACE		FACILITY NUMBER:	306004796
ADMINISTRATOR:	HILES, LINDA		FACILITY TYPE:	740
ADDRESS:	18800 FLORIDA ST		TELEPHONE:	(714) 848-8811
CITY:	HUNTING BEACH	STATE: CA	ZIP CODE:	92648
CAPACITY:	185	CENSUS: 146	DATE:	12/13/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Admininistrator, Zehra Syed		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff failed to meet resident's needs.
Staff is not responding timely to resident calls
Facility has insufficient staff
Facility staff are not dispensing medication as prescribed
Personal Rights

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jenifer Tirre made a unannounced visit and met with Administrator Zehra Syed to discuss the findings for the above allegations. The investigation consisted of interviews and review of documentation such as Physician’s report, Medication Order, Physician Visit form and Resident Assessments.
The Investigation was completed by department and revealed the following:
On 12/16/2020 the department received allegations that facility staff failed to meet resident’s needs, staff is not responding timely to resident’s calls, facility has insufficient staff, facility staff are not dispensing medication as prescribed and personal rights violation.
Based off interviews with residents, four of four residents have stated facility is meeting their needs and feel safe with staff at facility. Interviews with residents revealed that two of four residents state that staff answer their calls in timely manner averaging 10 minutes response time. Interviews with residents revealed that one of four residents feel that facility has had insufficient staffing previously at facility. Interviews with residents also revealed that three of four residents receive prescribed medications in timely manner. CONTINUED 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

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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Control Number 22-AS-20201216092545

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: HUNTINGTON TERRACE	FACILITY NUMBER: 306004796
	VISIT DATE: 12/13/2023

NARRATIVE

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Based off interviews and statements conducted with staff, six of six staff state they try to meet the needs of their residents as best as they can, respond to calls within 10 to 15 minutes and has sufficient staff on site. Interviews revealed that during 2020 to 2021, facility used staffing agencies to help fill in shifts. Interviews with Four of Four staff responsible for medications stated resident 1 received medication as prescribed however mentioned that resident 1 medication times would vary depending on resident’s schedule. Interviews with staff revealed resolution in Resident 1’s medication schedule.

Interview with Resident 1 revealed that Resident 1 stated they have no issues with staffing and stated staff assist with ADL’S such as showering, toileting, medication and transporting to facility dining area. Interview revealed that resident confirms if they have an issue with facility, they bring attention to issue. Resident confirms they like living at facility and feels safe in facilities care.

During investigation, LPA reviewed documentation and investigation revealed the following: Facility Assessment records dated from 3/29/2020 to 11/28/2023 revealed that Resident 1 has daily status checks 4 times per shift, 12 times a day. Facility Assessments are updated every 6 months. Hospice Records revealed that Resident 1 received weekly showering and wound care from 9/16/2020 to 12/23/2020. Facility notification revealed discontinued Hospice care for Resident 1 on 1/29/2021.

This department has investigated these allegations and based on LPA’s observations, and interviews which were conducted investigation revealed conflicting reports. Although the allegations may have happened or is valid, there is no preponderance of evidence to prove the alleged violations did or did not occur as reported, therefore the allegations are all deemed UNSUBSTANTIATED.

An exit interview was conducted with Administrator and a copy of report along with LIC 811 Confidential Names List was provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

LIC9099 (FAS) - (06/04)

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