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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005884
Report Date: 11/20/2025
Date Signed: 11/20/2025 01:19:07 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
10/07/2022 and conducted by Evaluator Jessica Cho
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20221007135859
FACILITY NAME:LUXURY LIVING SENIOR CARE HUNTINGTON BEACHFACILITY NUMBER:
306005884
ADMINISTRATOR:LE, TINFACILITY TYPE:
740
ADDRESS:7261 SUNBREEZE DR.TELEPHONE:
(714) 600-7083
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY:6CENSUS: 6DATE:
11/20/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Jayvee Angeles- CaregiverTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Facility is not following the proper protocol for COVID-19.
Resident on Hospice transported via non-medical transportation.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jessica Cho made an unannounced subsequent visit to continue the investigation into the above allegations. LPA was greeted and granted entry by Caregiver Jayvee Angeles and explained the reason for the visit. Administrator (Admin) Ban Nguyen was also advised of the visit by telephone at 8:45am today and gave verbal consent authorizing staff to sign said report.

On October 7, 2022, the Department received the complaint, and the investigation was initiated by LPA Andrea Mendivil on October 13, 2022 with a subsequent visit conducted by LPA Jenifer Tirre on November 18, 2022. During the course of the investigation, a facility tour and two staff interviews were conducted, and copies of facility records were obtained: Resident Roster, Face Sheet, Phsyician's Reports, Preplacement Appraisal, Needs and Services Plan, Admission Agreement, text messages, and hospice records for Resident #1 (R1). The investigation is as follows: Regarding the allegation, facility is not following the proper protocol for COVID-19, it is alleged that the facility was not enforcing masks for the visitors.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
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 2
Control Number 22-AS-20221007135859
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: LUXURY LIVING SENIOR CARE HUNTINGTON BEACH
FACILITY NUMBER: 306005884
VISIT DATE: 11/20/2025
NARRATIVE
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On today's date, LPA Cho observed masking and Coronavirus (COVID-19) signs posted on the front door with masks and hand sanitizers provided in the entry way. LPA Cho was greeted by staff wearing a mask. LPA reviewed the resident roster dated September 15, 2025, and the residents currently registered to the facility were not present at the time when the complaint was received. LPA interviewed two staff both denying the allegation indicating that COVID-19 protocol and visitation policy was strictly enforced including masking, and confirmed masks were worn properly by all visitors, staff, and residents.

Regarding the allegation, resident on hospice transported via non-medical transportation, it is alleged that the transfer in the vehicle caused R1 to decline. R1 was admitted to the facility on August 1, 2021 per the face sheet. Hospice agreement confirms R1 was admitted to hospice on February 25, 2022 with a diagnosis of Alzheimer's Disease. Per the Department's COVID-19 records, the census was five on October 6, 2022. Four out of five residents and two out of two staff tested positive on September 30, 2022. Because R1's roommate and all the other residents tested positive with COVID-19, R1's representative had agreed to move R1 to an alternative location and responded with a "Thank you!!" which was communicated via text on September 30, 2022 at 3:30pm. Based on the review of the admission agreement signed by R1's representative, the option for facility to provide transportation was declined. According to the admission agreement, facility is responsible to "plan and arrange" transportation which is covered under Basic Services. For non-emergency transportation, Transportation Policy indicates that "if a resident requires unscheduled non-emergency medical transportation, the facility will arrange for a taxi or other transport service to transport the resident." In R1's situation, Admin had indicated that R1 was transported by the facility vehicle due to 911 emergency not providing non-emergency medical transport and R1's family not taking action to provide transport even though it was declined on the agreement. Admin stated that the facility vehicle (van) which had access to a ramp, transferred resident safely. Based on the review of hospice records, there was no evidence that the facility vehicle transfer was related to, or resulted in R1's decline.

Therefore, based on observation, interviews, and record review, the allegations, facility is not following the proper protocol for COVID-19 and resident on hospice transported via non-medical transportation are deemed unsubstantiated.

An exit interview was conducted by telephone with Ban Nguyen and Caregiver Jayvee Angeles, and a copy of this report was provided at exit.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
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 2