306004796-10-22-2025-22-AS-APAO-DMWNLQ-20251029103356

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004796
Report Date: 10/22/2025
Date Signed: 10/22/2025 05:11:03 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
09/28/2021 and conducted by Evaluator Jenifer Tirre

COMPLAINT CONTROL NUMBER: 22-AS-20210928135349

FACILITY NAME:	HUNTINGTON TERRACE		FACILITY NUMBER:	306004796
ADMINISTRATOR:	GREGORY CASE		FACILITY TYPE:	740
ADDRESS:	18800 FLORIDA ST		TELEPHONE:	(714) 848-8811
CITY:	HUNTING BEACH	STATE: CA	ZIP CODE:	92648
CAPACITY:	185	CENSUS: 172	DATE:	10/22/2025
		UNANNOUNCED	TIME BEGAN:	07:16 AM
MET WITH:	Mike Marion		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Resident sustained a fall while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jenifer Tirre made a unannounced visit and met with Administrator Mike Marion to discuss the findings for the above allegations. The investigation consisted of interviews and review of Residents (R1) records such as Physician’s report, incident report and Assessment
The Investigation was completed by department and revealed the following:
On September 28, 2021, the department received allegations that Resident sustained a fall while in care. Based off Interviews with staff, three of five staff members stated that they worked at facility during time R1 resided but does not recall R1 and their level of care needed. Two of Five staff interviews stated that they were not working at that time R1 resided at facility. Interviews with witnesses revealed that one of two witnesses (W1) states that per a medic report for UCI Health, R1 had a witnessed ground level fall (glf). W1 was not present at facility at time of fall. Per interview with W2 revealed that R1 had a fall at facility on September 24, 2021, W2 heard a thud while R1 was in bathroom, W2 found R1 on floor.

CONTINUED ON 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025

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-20210928135349

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: 10/22/2025

NARRATIVE

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Witness called staff for assistance and R1 was transported to hospital. W2 stated that R1 returned to facility on September 28, 2021. W2 stated that R1 uses a walker and is able to complete Activities of daily living on their own. W2 stated they had no issues with level of care being provided for R1.

Per Record review Facility Internal incident report dated September 24, 2021 states that R1 had a witnessed fall caused by seizure. Facility called 911 Emergency personnel.

R1’s Physician’s Report dated June 17, 2020 states R1 is Ambulatory, has a diagnosis of Muscle Atrophy, receives skilled nursing services & therapy. Physician’s Report also states R1 is able to communicate needs, able to independently feed themselves, moderately independent in bathing and dressing. Per R1’S Advantage Assessment dated 6/23/20, indicates R1 is a moderate fall risk and requires stand by assistance while toileting and grooming.

This department has investigated the allegation Resident sustained a fall while in care. Based on interviews and Records reviewed, investigation revealed conflicting reports. Although the allegations may have happened or is valid, there is no preponderance of evidence to prove the alleged violations did or did not occur as reported, therefore the allegations are deemed UNSUBSTANTIATED.

An exit interview was conducted with Administrator Mike Marion and a copy of report was provided

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025

LIC9099 (FAS) - (06/04)

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