300606862-9-23-2025-22-AS-RMRT-DLSRFS-20250923125935

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300606862
Report Date: 09/23/2025
Date Signed: 09/23/2025 01:05:18 PM

Document Has Been Signed on 09/23/2025 01:05 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	HUNTINGTON BEACH GUEST HOME II		FACILITY NUMBER:	300606862
ADMINISTRATOR/ DIRECTOR:	L. MANGURAY, N.& W.URETA		FACILITY TYPE:	740
ADDRESS:	8382 CRANE CIRCLE		TELEPHONE:	(714) 536-2375
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92646
CAPACITY: 6		CENSUS: 5	DATE:	09/23/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:31 AM
MET WITH:	Loida Manguray, Administrator		TIME VISIT/ INSPECTION COMPLETED:	01:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPAs) Michael Tea and Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPAs were greeted and granted entry by Loida Manguray, Administrator (AD) and LPAs explained the purpose of the visit. The facility is a two-story, six bedroom, two bathroom residence with an approved fire clearance of six non-ambulatory residents of which three may be on hospice. Staff member and an additional person live on the second floor who is not background cleared. An immediate civil penalty of $500 LIC 421BG was assessed for the additional person. The facility currently has a census of five residents in care with four on hospice. A technical violation will be given. Licensee produced email communication requesting an increase of hospice waiver to four residents. LPA advised AD and Licensee (LE) to not accept additional hospice residents until the waiver is approved and to follow-up with LPA or Licensing Program Manager (LPM) for a timely response. During today’s visit, LPAs toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in two of two resident bathrooms, and testing auditory devices on all exits. The hot water temperature measured 105.2 degrees Fahrenheit and all smoke detectors were operational. The fire extinguisher is charged and was serviced on April 8, 2025. The facility’s last fire drill was conducted on March 10, 2025. Administrator was advised to conduct fire drills quarterly and a technical violation was given. (Continued from LIC 809-C)

NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: RoseMarie Ruppert
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 BEACH GUEST HOME II	FACILITY NUMBER: 300606862
	VISIT DATE: 09/23/2025

NARRATIVE

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(Continued from LIC 809)

LPAs inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. There are plenty of fruits and vegetables in the refrigerator. Emergency water is located in the garage and emergency food is in the front closet. Sharps and knives are secured under the sink and hazardous chemicals are stored in the garage. All appliances were in working order. LPA Tea observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed.

LPAs toured the exterior of the property and there were no hazards or obstacles in pathways and there were plenty of shaded seating areas for residents to sit outdoors. There is a large area for outdoor activities and LPAs observed fitness cycling equipment for residents to use. Outdoor area is shared between the two Huntington Beach Guest Homes 1 and 2 which are adjacent to one another.

LPAs reviewed two of two staff training and fingerprint records and conducted a complete review of resident records. LPA Tea interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPAs confirmed that administrator has a current administrator certificate which expires on May 1, 2026. LPA confirmed facility profile information was correct, fees are current and the primary language is English.

The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations.
An exit interview was conducted with Loida Manguray, Administrator and a copy of this report was given to the facility along with a copy of the LIC 858, LIC 859; LIC 9102-TVs;LIC 809-D; LIC 421BG and Appeal Rights.

NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: RoseMarie Ruppert
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/23/2025 01:05 PM - It Cannot Be Edited

Created By: RoseMarie Ruppert On 09/23/2025 at 12:28 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: HUNTINGTON BEACH GUEST HOME II	FACILITY NUMBER: 300606862
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/23/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87355(e)

Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPAs observations and interviews, the licensee did not comply with the section cited above in one of one persons which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 09/24/2025
	Plan of Correction
1 2 3 4	Licensee (LE) and Administrator (AD) will provide Live Scan fingerprinting for one of one persons by the Plan of Correction Date. LE and AD to email LPA with documentation.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Alisa Ortiz
NAME OF LICENSING PROGRAM MANAGER:

	RoseMarie Ruppert
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025

LIC809 (FAS) - (06/04)

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