306006262-2-11-2026-22-AS-APAO-DRF7KG-20260218204355

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006262
Report Date: 02/11/2026
Date Signed: 02/11/2026 06:28:01 PM

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
07/31/2025 and conducted by Evaluator Eboni Bentley

COMPLAINT CONTROL NUMBER: 22-AS-20250731152626

FACILITY NAME:	REVIVAL MENTAL HEALTH, LLC		FACILITY NUMBER:	306006262
ADMINISTRATOR:	MICHAELIS, TYLER		FACILITY TYPE:	772
ADDRESS:	9879 HAMILTON AVE		TELEPHONE:	(949) 606-4681
CITY:	FOUNTAIN VALLEY	STATE: CA	ZIP CODE:	92708
CAPACITY:	6	CENSUS: 6	DATE:	02/11/2026
		UNANNOUNCED	TIME BEGAN:	05:40 PM
MET WITH:	Sophie Clark, Behavioral Medication Tech		TIME COMPLETED:	06:45 PM

ALLEGATION(S):

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Staff do not prevent clients engaging in inappropriate conversations with other clients in care
Staff did not ensure clients personal property was safely secured
Staff did not ensure clients received therapy sessions while in care
Staff did not ensure clients needs and services plan was followed

INVESTIGATION FINDINGS:

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On February 11, 2026, Licensing Program Analyst (LPA) Eboni Bentley made an unannounced visit for the purpose of delivering the investigation findings into the above allegations. LPA contacted Program Director (PD) Trevor Slaney and explained the reason for the visit. PD granted permission and designated staff Sophie Clark to sign the repot for today’s visit.

On July 31, 2025, the Department received a complaint with multiple allegations and the investigation was initiated on August 7, 2025. During the course of the investigation, the Department interviewed clients and staff and obtained the following documentation: Client/Staff Rosters, Staff Contacts, Staff Schedules, as well as Client Face Sheet, Physician's Report, Admission Agreement, and Appraisals.

CONTINUE TO LIC9099-C....

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2026

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-20250731152626

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
	VISIT DATE: 02/11/2026

NARRATIVE

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Regarding the allegation, Staff do not prevent clients engaging in inappropriate conversations with other clients in care, it is alleged do not intervene when clients engage in inappropriate conversations. Eight out of eight individuals interviewed denied the allegation including all staff interviewed and all clients interviewed. C3 stated as a group the clients have their moments, but everyone hangs out and gets along. C4 denied the allegation and said no, everything seems civil.

Regarding the complaint allegation: Staff did not ensure clients personal property was safely secured, eight out of eight individuals interviewed denied the allegation including all staff and all clients interviewed. Five out of five clients denied having anything stolen from them or removed without their permission. According to S1, rooms are randomly searched for contraband, like sharp objects and electronics. When a prohibited item is found in the client’s room, the item is set aside, and when the client returns from group, staff talk to the client and explain why the item will be placed in the clients personal locker in the garage which remains locked. The keys to the personal lockers in the garage, are locked in the safe only the staff have access to. A staff member is always present when a clients it accessing items from the personal locker area. During the tour of the facility at the beginning of the visit, S1 explained the locker system for the clients personal property during the initial tour of the facility. Photos were taken.

Regarding the complaint allegation: Staff did not ensure clients received therapy sessions while in care, eight out of eight individuals interviewed denied the allegation including all staff and all clients interviewed. S2 stated they’re responsible for client intake and the do all the risk assessment and treatment planning. S2 meets with the clients on a weekly basis for treatment plan review and the client signs off on the treatment review weekly. During an interview with Staff 1, the staff member stated the clients see the therapist for treatment planning and goal setting. Four of the five clients interviewed, confirmed they meet with staff 2 on a weekly basis and review their treatment plan. The fifth client arrived last prior to interview and only completed his intake paperwork and at the time of the interview had only attended one introductory meeting. During the visit, LPA’s requested documents to review and the staff provided access to an electronic filing system, Kipu that stores all client records including the weekly treatment plan reviews. Records reviewed revealed the facility is ensuring clients are receiving weekly therapy sessions while in care, unless refused.

CONTINUE TO LIC9099-C....

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2026

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20250731152626

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
	VISIT DATE: 02/11/2026

NARRATIVE

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Regarding the complaint allegation: Staff did not ensure clients needs and services plan was followed, eight out of eight individuals interviewed denied the allegation including all staff and all clients interviewed. Four of the five clients interviewed, confirmed they meet with staff 2 on a weekly basis and review their needs and services plan. The fifth client arrived last prior to interview and only completed his intake paperwork and at the time of the interview had only attended one introductory meeting. During the visit, LPA’s requested documents to review and the staff provided access to an electronic filing system, Kipu that stores all client records including the weekly needs and service plans. LPA reviewed records and confirmed the facility is ensuring clients are receiving care according to needs and service plans.

Based on interviews that were conducted and records reviewed, the Department is unable to ascertain if the above allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, the allegation are deemed UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was provided.

An exit interview was conducted and a copy of this report provided at the end of the visit to designated staff Sophie Clark, for Program Director Trevor Slaney.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2026

LIC9099 (FAS) - (06/04)

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