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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006262
Report Date: 11/20/2025
Date Signed: 11/20/2025 05:07:56 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
11/04/2025 and conducted by Evaluator Eboni Bentley
COMPLAINT CONTROL NUMBER: 22-AS-20251104114342
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: 4DATE:
11/20/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Trevor Slaney - Program DirectorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff did not maintain a comfortable temperature in the facility.
Facility did not provide comfortable sleeping accommodations.
Staff failed to treat clients with dignity and respect.
INVESTIGATION FINDINGS:
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On November 20, 2025, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced to conduct a subsequent complaint investigation visit into the above allegations. LPA introduced self and stated the purpose of the visit to staff. Program Director (PD) Trevor Slaney later arrived and remained throughout the visit to assist with the investigation.

During today’s visit, LPA observed four clients present and three staff on duty. LPA conducted a tour of the facility with staff and observed no imminent health and safety issues. LPA obtained copies of pertinent documents for clients including facility records: Client Roster (LIC9020), Personnel Record (LIC500), staff contacts and access to the electronic client records.


CONTINUE TO LICE9099-C....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
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 3
Control Number 22-AS-20251104114342
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: 11/20/2025
NARRATIVE
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Regarding the allegation: Staff did not maintain a comfortable temperature in the facility, it was alleged that the facility is hot, muggy, and does not maintain comfortable room temperatures. LPA conducted a tour of the facility on November 13, 2025 and November 20, 2025 and observed wall thermostats located in downstairs dining room area and upstairs in Room #1 were between 67 and 70 degrees Fahrenheit on both dates. The thermostat located in Room #1 controls all rooms upstairs and the thermostat in the dining room area controls temperature for all downstairs rooms. Thermostats are locked and staff stores the key in a lock box, in the medication office. Fan were observed in each client’s room, with at least one running during the initial visit. Staff 1 (S1) stated the facility provides fans for each room and adjusts room temperature when clients’ request adjustments. Five out of six clients stated staff keep the facility at comfortable temperatures. Client 2 (C2) stated there are always fans available and staff turns on the air when requested. LPA observed and tested the wall air condition thermostats located in the dining room area and Room #1. Unit was found to be operable.

Regarding the allegation: Facility did not provide comfortable sleeping accommodations, it was alleged that facility does not provide comfortable beds for clients, causing clients to lose sleep and purchase mattress pads at their own expense. During tour, LPA sat on client beds and found them to be in good condition. Interviews were conducted and five out of six clients stated they found their beds to be comfortable and in good condition. One client stated their bed was okay and sometimes uncomfortable but it does not cause them to lose sleep. PD stated if a client complains about sleeping accommodations, they would ask questions to determine what was causing the discomfort and offer to purchase a mattress pad for the client at facility’s expense. Staff 2 (S2) stated the beds are uncomfortable for some clients and reported witnessing facility purchase items to help clients with sleeping comfort in the past, such as weighted blankets and body pillows.

Regarding the allegation: Staff failed to treat clients with dignity and respect, it is alleged staff made demeaning comments to client, harass, embarrass, and do not treat clients with respect and dignity. During the investigation, six out of six clients stated staff are nice and that clients are always treated with dignity and respect. S1 denied making any demeaning comments to any clients at any time. Two clients and one staff present during the alleged movie incident reported that staff was professional by ending the movie and redirection behaviors.

CONTINUE TO LICE9099-C....
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20251104114342
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: 11/20/2025
NARRATIVE
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Based on observations made and information received during interviews conducted, LPA is unable to determine if facility did or did not maintain a comfortable temperature, provided comfortable sleeping accommodations for clients, and whether or not staff failed to treat clients with dignity and respect. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are deemed UNSUBSTANTIATED.

An exit interview was conducted with Program Manager Trevor Slaney, and a copy of this report was provided at the end of the visit.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3