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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604454
Report Date: 08/14/2025
Date Signed: 08/14/2025 10:24:49 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
08/05/2025 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20250805124533
FACILITY NAME:HUNTINGTON MANORFACILITY NUMBER:
374604454
ADMINISTRATOR:DERAFERA, TESSFACILITY TYPE:
740
ADDRESS:14755 BUDWIN LNTELEPHONE:
(858) 748-3381
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:21CENSUS: 21DATE:
08/14/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Administrator Lynn DrummondTIME COMPLETED:
06:30 PM
ALLEGATION(S):
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5
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7
8
9
Facility has an accessible body of water.
Licensee did not keep facility free from trip hazard.
Facility is in disrepair.
INVESTIGATION FINDINGS:
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2
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5
6
7
8
9
10
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13
Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to the facility to commence and conclude a complaint investigation. LPA was greeted by Caregiver Marissa Sabrino and Med-tech Gerald Madla identified herself, and was allowed entrance into the facility and later met with Administrator Lynn Drummond to whom was explained the purpose of the visit.

The investigation included a facility tour, staff interviews, a facility records review, and secured photos.

The facility is Licensed for 21 residents ages 60 and over, all of which may be non-ambulatory, 12 may be bedridden, and the facility is approved for 15 residents receiving Hospice care services. Staff interviews and a review of facility records revealed during today’s visit the census was 21 residents, which included four (4) that were receiving Hospice services and three (3) who were bedridden.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
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 6
Control Number 08-AS-20250805124533
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 MANOR
FACILITY NUMBER: 374604454
VISIT DATE: 08/14/2025
NARRATIVE
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On August 5, 2025, the Department received a complaint that alleged the facility was in disrepair, the facility did not provide a safe environment, and the facility’s fishpond was enclosed by a dilapidated gate.
During a facility tour, accompanied by Med-tech Madla, LPA observations corroborated several areas of disrepair at the facility, including damaged flooring in passageways which posed a fall risk to residents in care. LPA's observations also confirmed the gate in front of the facility’s fishpond was so severely deteriorated it was accessible to residents in care.

Based on the investigation the allegations were determined to be SUBSTANTIATED. A substantiated finding means the preponderance of evidence was met.

Pursuant to the California Code of Regulations, Title 22, Division 6, deficiencies are being cited on the attached LIC9099D and plans of corrections were jointly developed with Administrator Drummond. An exit interview was conducted with the Administrator; a copy of this report and Licensee's Rights (LIC9058) will be provided.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
08/05/2025 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20250805124533

FACILITY NAME:HUNTINGTON MANORFACILITY NUMBER:
374604454
ADMINISTRATOR:DERAFERA, TESSFACILITY TYPE:
740
ADDRESS:14755 BUDWIN LNTELEPHONE:
(858) 748-3381
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:21CENSUS: 21DATE:
08/14/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Administrator Lynn DrummondTIME COMPLETED:
06:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff does not keep resident's records confidential.
Staff used resident's bedroom as a passageway to another room.
Staff do not ensure that food is adequately stored.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to the facility to commence and conclude a complaint investigation. LPA was greeted by Caregiver Marissa Sabrino and Med-tech Gerald Madla identified herself and was allowed entrance into the facility and later met with Administrator Lynn Drummond to whom was explained the purpose of the visit.

The investigation included a facility tour, staff interviews, a facility records review, and secured photos.

On August 5, 2025, the Department received a complaint that alleged staff did not keep resident's records confidential. More specifically, it was alleged that facility staff posted pictures of residents’ and medical information on the front of their room doors at the facility. A facility tour revealed only the residents’ names were posted on each of their doors. It was also alleged that staff used residents’ bedroom doors as passageways to enter another room. A facility tour and review of the facility sketch revealed all rooms had their own private entrance into their rooms that were not attached to another room.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 08-AS-20250805124533
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 MANOR
FACILITY NUMBER: 374604454
VISIT DATE: 08/14/2025
NARRATIVE
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Additionally, it was alleged that staff did not ensure that food was adequately stored. During the facility tour LPA observed the food was properly stored and labeled with expiration dates.

Based on the investigation a preponderance of evidence did not exist to prove that the alleged violation(s) occurred, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Administrator Drummond to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

This is an amended version of the original report dated August 14, 2025.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Citations on this Visit Report are Under Appeal!

Control Number 08-AS-20250805124533
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 MANOR
FACILITY NUMBER: 374604454
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
08/15/2025
Section Cited
CCR
87307(e)(2)(A)
1
2
3
4
5
6
7
The licensee shall supervise...as needed...pursuant to Section 87457 or ...87463...when residents are in proximity to...Fishponds...licensee shall ensure...bodies of water are inaccessible through...fencing, covering, or other.. when not in...use by residents.

This requirement was not met as evidenced by:
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Staff boarded up the fishpond during site visit. Staff will be replacing the fence with a new gate by Monday August 18, 2025.
And provide Licensing with proof of replacement.
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A facility tour revealed the gate to a fishpond had deteriorated to a point of ability to access the body of water.


This posed an immediate safety risk to 18:21 residents in care.
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9
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Under Appeal
Type A
08/15/2025
Section Cited
CCR
87307(D)(6)
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5
6
7
The following space and safety provisions shall apply to all facilities: All outdoor and indoor passageways and stairways shall be kept free of obstruction.

This requirement was not met as evidenced by:
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5
6
7
Licensee will temporarily fix the damaged areas with plywood in the interim of replacing the damaged floors.

Licensee will provide proof of correction by POC due date.
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A facility tour revealed the flooring in the facility hallway into the main dining hall was damaged and buckled creating a trip hazard.


This posed an immediate safety risk to 18:21 residents in care.
8
9
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12
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14
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: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Citations on this Visit Report are Under Appeal!

Control Number 08-AS-20250805124533
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 MANOR
FACILITY NUMBER: 374604454
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
09/16/2025
Section Cited
CCR
87307(D)(2)
1
2
3
4
5
6
7
Personal Accommodations and Services: The following... safety provisions shall apply...The premises shall be maintained in... good repair and shall provide a safe and healthful environment.
This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee will contact maintenance to fix issues of disrepair throughout the facility by POC due date.
8
9
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12
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14
A facility tour revealed several areas of disrepair throughout the facility housing and grounds.

This posed a potential safety and personal rights risk to 21:21 residents in care.
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7
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: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6