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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006262
Report Date: 01/20/2026
Date Signed: 01/20/2026 05:40:03 PM

Substantiated


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
01/12/2026 and conducted by Evaluator Eboni Bentley
COMPLAINT CONTROL NUMBER: 22-AS-20260112091827
FACILITY NAME:REVIVAL MENTAL HEALTH, LLCFACILITY NUMBER:
306006262
ADMINISTRATOR:MICHAELIS, TYLERFACILITY TYPE:
772
ADDRESS:9879 HAMILTON AVETELEPHONE:
(949) 606-4681
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:6CENSUS: 6DATE:
01/20/2026
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Trevor Slaney - Program DirectorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility is dirty and unsanitary.
INVESTIGATION FINDINGS:
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Regarding the allegation: Facility is dirty and unsanitary, it was alleged that the facility is not clean and sanitary for clients in care. During today’s visit, LPA conducted a tour of the inside and outside of the physical plant with PD Slaney and observed multiple common areas that were dirty and unsanitary, including walls, doors and the banister on the stairs. The kitchen counter and stove were observed dirty with food droppings that had not been picked up and sanitized, cabinets below the sink were dirty and in need of deep cleaning, and floors throughout the facility were dirty and required sweeping and moping. The outside seating areas and roof over the outdoor patio were also observed dirty and in need of cleaning.

Based on the information gathered during the investigation through record review, the preponderance of evidence standard has been met for the allegations: Facility is dirty and unsanitary is deemed SUBSTANTIATED. Deficiencies are being cited as per the Title 22, Division 6, Chapter 2 of the California Code of Regulations. See the attached LIC9099-D. An exit interview was conducted with Program Director Trevor Slaney, and a copy of this report, and the appeal rights were provided at the end of the visit.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2026
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 2
Control Number 22-AS-20260112091827
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: REVIVAL MENTAL HEALTH, LLC
FACILITY NUMBER: 306006262
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/27/2026
Section Cited
CCR
81087(a)
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81087 (a)The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.
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The Program Director stated they will retrain staff on how to properly clean the facility, conduct a deep cleaning of the interior and exterior of the facilty, and submit proof to CCLD via email by POC due date.
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Based on observations, the facility did not comply with the section cited above which poses a health and safety risk to persons in care. LPA observed multiple common areas that were dirty and unsanitary, including walls, doors and the banister on the stairs, kitchen, outdoor seating and patio covering.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2