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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002908
Report Date: 05/12/2022
Date Signed: 05/12/2022 03:23:06 PM


Document Has Been Signed on 05/12/2022 03:23 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:BEACH HOMES IIFACILITY NUMBER:
306002908
ADMINISTRATOR:TRISH BEACHFACILITY TYPE:
740
ADDRESS:2572 COLUMBIA DRIVETELEPHONE:
(714) 549-5877
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY:6CENSUS: DATE:
05/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Trish BeachTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Jessica Cho made an unannounced required annual (mitigation) inspection in this facility. LPA was greeted and granted entry by Administrator (Admin) Patricia Beach who was then conducting a meeting with the staff from all the Beach Homes I to IV. LPA completed the Coronavirus 2019 (COVID-19) screening procedure, LPA stated the purpose of the visit , and then toured the facility with Andy Beach. LPA observed that the Administrator's Certificate was expired on 04/18/22, and Admin showed proof of completion of course work via the Admin's cell phone.

The facility is a single level structure and licensed for six non-ambulatory residents and has a hospice waiver for two residents. There is one resident in hospice care as of today. For this visit, there are six residents in care and two staff members on duty. LPA toured the interior and exterior portions of the facility. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke detectors, carbon monoxide, and auditory exit alarms tested operational. Bathrooms were observed to be in good repair; and provided with handrails and nonskid - floor mats. Hot water was measured between the ranges of 103.6 to 111.3 degrees Fahrenheit in all seven bathrooms. Facility met the minimum two day perishable and seven day non-perishable food stock requirements. LPA observed sharp items and medications were inaccessible to the residents in care. The fire extinguishers were mounted and charged. LPA observed a camera on top of the fireplace mantle and kitchen cabinet. Per Admin, the two cameras were approved by the Department. LPA requested an updated floor plan reflecting the changes of the camera. For the exterior portion, the grounds were free of tripping hazards and the side exit door was self-latching and self-closing. LPA reviewed the approved COVID-19 Mitigation Plan.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: BEACH HOMES II
FACILITY NUMBER: 306002908
VISIT DATE: 05/12/2022
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LPA discussed Assembly Bill 665 that requires a licensee of any adult or senior care residential facility that has internet service to provide at least one internet access device, such as a computer, smart phone, tablet or other device, that: can support real-time interactive applications; is equipped with video conferencing technology, including microphone and camera functions; and is dedicated for client or resident use.


For this visit, there are no deficiencies cited in this review as per Title 22 Division 6 of the California Code of Regulations. An Advisory Note (LIC9102) was issued during the visit and the licensee will follow-up with the corrections. An exit interview was conducted with Administrator Patricia Beach, and a copy of this report was provided.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
LIC809 (FAS) - (06/04)
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