306004415-6-5-2020-22-AS-AORZ-BQDSMV-20200608140035

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004415
Report Date: 06/05/2020
Date Signed: 06/05/2020 04:04:44 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/06/2020 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200206133044

FACILITY NAME:	SEASIDE TERRACE RETIREMENT COMMUNITY		FACILITY NUMBER:	306004415
ADMINISTRATOR:	KAROLINA FIL		FACILITY TYPE:	740
ADDRESS:	9925 LA ALAMEDA AVENUE		TELEPHONE:	(714) 962-5531
CITY:	FOUNTAIN VALLEY	STATE: CA	ZIP CODE:	92708
CAPACITY:	250	CENSUS: 137	DATE:	06/05/2020
		UNANNOUNCED	TIME BEGAN:	03:16 PM
MET WITH:	Ephantus Warui, Administrator		TIME COMPLETED:	03:43 PM

ALLEGATION(S):

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Resident was sexually assaulted

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosie Quiroz conducted a tele visit on this day for the purpose of delivering findings regarding complaint control # 22-AS-20200206133044. Today’s visit was conducted via tele visit due to COVID 19 precautionary measures. This Complaint was investigated by Community Care Licensing Department’s Investigation Bureau.
The following was concluded:
The Department received an allegation that a resident was sexually assaulted.
The investigation included record review and interviews with pertinent parties. The investigation revealed that on 2/03/2020, Resident 1 (R1) reported that an unknown man undressed themselves and pushed R1’s face into their genitals at the facility.
The interviews conducted and documentation review revealed that R1 has a diagnose of Mild Cognitive Impairment and is able to follow instructions and able to communicate needs.

CONTINUED ON NEXT PAGE LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20200206133044

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: SEASIDE TERRACE RETIREMENT COMMUNITY	FACILITY NUMBER: 306004415
	VISIT DATE: 06/05/2020

NARRATIVE

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The investigation revealed that R1 stated they voluntarily engaged in sexual acts with Resident 2 (R2) at the facility in R1’s room, despite initially reporting they had not consented. R1 reported they were not threatened or hit by the other resident. R2 who was reported to have engaged in sexual acts with R1 moved out of the facility on November 2019. An interview was conducted with R2 at their current residence. During the interview, R2 was not alert nor orientated and was unable to provide details as to sexual acts engaged between themselves and R1. The Witness interviewed reported R1 reported feeling ashamed of sexual acts engaged in due to Religious beliefs.
The facility Administrator reported residents can move around the facility freely; date and engage in relationships with other residents and they can visit each other’s bedroom during facility visiting hours from 0900-1900.
Multiple interviews were conducted and during the interviews, it was determined that the allegation could not be corroborated by evidence nor witnesses.
Therefore, based on the preponderance of evidence gathered through multiple interviews and documents obtained; the allegation “resident was sexually assaulted" is deemed to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.
An exit interview was conducted with Administrator Ephantus Warui via telephone. The report was sent via email and an electronic email read receipt confirms receiving of the report. Administrator Warui agrees to review the report and to send the signed report back to the LPA Quiroz via email.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2020

LIC9099 (FAS) - (06/04)

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