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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002908
Report Date: 06/24/2024
Date Signed: 06/24/2024 04:08:30 PM


Document Has Been Signed on 06/24/2024 04:08 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
ORANGE COUNTY ASC, 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: 5DATE:
06/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:18 PM
MET WITH:Sam Chiascione - AdministratorTIME COMPLETED:
04:22 PM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. arrived at the facility unannounced for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into facility by Caregiver Dolores Mancia. LPA met with Administrator Samantha Chiascione.

The facility is a one-story home with six resident bedrooms, seven bathrooms, kitchen, dining room, living room, staff room, staff bathroom, backyard and attached 2-car garage. LPA observed residents lounging in their rooms and in the living room.

All resident rooms had the required elements, including bed, chair, closet space and ample lighting.
Facility has extra linens for residents in the hallway cabinets. Restrooms are stocked with soap and paper towels and have hand washing postings. LPA observed facility has emergency food and water supply. LPA noted Fire Extinguishers were last serviced on 5/8/2024. LPA observed hazardous items such as knives, chemicals and cleaners to be locked up in cabinets in the kitchen and garage. Knives are locked up separate from toxic chemicals. Medication for each client is kept locked in a cabinet in the kitchen. Exit gate is unlocked and self latching. LPA reviewed three resident and three staff files. LPA interviewed one staff and two residents. LPA reviewed three resident medications. LPA observed refrigerators and pantries to be stocked with a 2-day supply of perishable food and a 7-day supply of non-perishable food. LPA issued a citation at Beach Homes III (#306005495) on 5/15/2024 regarding the frequency of disaster drills conducted. Both homes have the same Administrator. Based on record review, LPA determined the facility applied the plan of corrections for Beach Homes III (#306005495) to Beach Homes II (#306002908). LPA issued a Technical Violation regarding disaster drills and advised AD to continue conducting quarterly drills as planned.

Based on today's inspection, no deficiency is being issued. An exit interview was conducted and a copy of
this report was provided.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Dwayne L MasonTELEPHONE: () -
LICENSING EVALUATOR SIGNATURE:
DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2024
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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