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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604375
Report Date: 08/26/2025
Date Signed: 08/26/2025 08:11:38 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/26/2025 and conducted by Evaluator Dang Nguyen
COMPLAINT CONTROL NUMBER: 08-AS-20250826143902
FACILITY NAME:HUNTINGTON HOUSEFACILITY NUMBER:
374604375
ADMINISTRATOR:DERAFERA, TESSFACILITY TYPE:
740
ADDRESS:14805 BUDWIN LANETELEPHONE:
(858) 513-0589
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:6CENSUS: 7DATE:
08/26/2025
UNANNOUNCEDTIME BEGAN:
06:00 PM
MET WITH:Caregiver Rosario "Pie" SalesTIME COMPLETED:
08:15 PM
ALLEGATION(S):
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Licensee operated the facility over capacity.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to commence a Complaint Investigation regarding the above allegation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Rosario "Pie" Sales.

The Complainant alleged that Licensee operated the facility over capacity. CCLD’s investigation involved an unannounced facility tour/welfare check and interviews of relevant staff, residents, and outside sources. The Department also reviewed pertinent administrative and care records.

According to the facility’s current/active CCLD-issued license (which also corresponds with the facility’s latest Fire Clearance) the facility is currently licensed to care for a maximum of six (6) residents.

[CONTINUED ON LIC 9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2025
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 08-AS-20250826143902
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: HUNTINGTON HOUSE
FACILITY NUMBER: 374604375
VISIT DATE: 08/26/2025
NARRATIVE
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[CONTINUED FROM LIC 9099]

During today’s visit, LPA observed, and staff interviews confirmed: The facility currently has seven (7) residents in care. Records and staff interviews showed that the seventh resident, Resident #7 (R7), moved into the facility on 08/25/2025. [See LIC811 Confidential Names List for a description of select person identifiers used in this report.]

Per LPA observation, R7 is currently in a bedroom with one other housemate/roommate. The room they share is sufficiently large/spacious to comfortably accommodate both residents, and this bedroom also has its own bathroom. The room has an immediate exterior exit door, which is appropriate for R7’s non-ambulatory status (per their latest LIC602 Physician's Report).

CCLD had prior received an application from Licensee to increase the facility’s capacity. However, this application is still pending / in process, and Licensee was not yet authorized to have more than six (6) residents in care at this time.

Based on records and interviews, a preponderance of evidence exists to show that Licensee operated the facility over capacity. The allegation is therefore Substantiated. One (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D page). Since the deficiency is also a violation of the facility’s Fire Clearance, an Immediate Civil Penalty of $500 was also assessed/charged (refer to the LIC421-IM page). A Plan of Correction was jointly developed with the Licensee.

An exit interview was conducted with Caregiver Rosario "Pie" Sales, to whom a copy of this report, the LIC 9099-D page, the LIC421-IM page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided. An electronic set of these same documents was E-mailed to Chief Operating Officer Lynn Drummond during today's visit.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20250826143902
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: HUNTINGTON HOUSE
FACILITY NUMBER: 374604375
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/26/2025
Section Cited
CCR
87204(a)
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87204 Limitations - Capacity and Ambulatory Status: “(a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time.” This requirement was not met, as evidenced by:
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Based on LPA observation and record review, the bedroom shared by R7 and their housemate is sufficiently large to comfortably accommodate both residents and has an immediate exit door appropriate to R7’s non-ambulatory status. Licensee’s application to increase facility capacity is pending with CCLD, resolving the immediate risk. No further action is required yet. If the described application is subsequently not approved, Licensee agrees to relocate R7 to come back into compliance.
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Based on LPA observation, records, and interviews, Licensee operated the facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. This posed an immediate health and safety risk to 1 of 7 residents (R7) in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3