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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004796
Report Date: 04/26/2024
Date Signed: 04/26/2024 03:47:33 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
10/06/2023 and conducted by Evaluator Jenifer Tirre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20231006141818
FACILITY NAME:HUNTINGTON TERRACEFACILITY NUMBER:
306004796
ADMINISTRATOR:GREGORY CASEFACILITY TYPE:
740
ADDRESS:18800 FLORIDA STTELEPHONE:
(714) 848-8811
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY:185CENSUS: 154DATE:
04/26/2024
UNANNOUNCEDTIME BEGAN:
02:02 PM
MET WITH:Executive Director, Zehra SyedTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff does not ensure reporting requirements are met for residents in care
INVESTIGATION FINDINGS:
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On this day Licensing Program Analyst (LPA) Jenifer Tirre made an unannounced visit to follow up on complaint investigation. LPA discussed purpose of the visit and allegations with Executive Director Zehra Syed.
The Investigation consisted of obtained records and interviews with Huntington Terrace Staff. On 10/06/2023 the department received allegations Staff does not ensure reporting requirements are met for residents in care. The Investigation was completed by the department and revealed the following: based on record review facility documents in several areas where they report changes based on resident’s care and needs. Facility uses a program called ICON Voice Friend where mass messages are sent out to residents, families and staff notifying of changes in the community such as reporting Covid or any other infectious diseases in the community. Record review also revealed that facility staff fill out end of day reports to update staff members of changes in condition of residents.
CONTINUED ON 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
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-20231006141818
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: 04/26/2024
NARRATIVE
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The end of day reports are provided by Med Tech’s to communicate with care giving team of updates. Record review reveals that facility sends out fax confirmations of incident reports submitted to Licensing Agency and Primary Care Providers of incidents with residents. LPA reviewed recent reports and fax confirmations documented.

Based on staff interviews investigation revealed that when an incident occurs with a resident, facility staff assess situation, if serious condition or at request of resident; resident may be sent out to hospital, family are contacted in conjunction with incident, Care Providers are notified as well as Licensing Agency.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation is deemed UNSUBSTANTIATED.


An exit interview was conducted with Executive Director and copy of this report along with appeal rights was left at facility.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2