306004415-7-7-2020-22-AS-AORZ-BRLPLE-20200717112438

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004415
Report Date: 07/07/2020
Date Signed: 07/07/2020 03:52:12 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
03/30/2020 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200330135256

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: 148	DATE:	07/07/2020
		UNANNOUNCED	TIME BEGAN:	03:04 PM
MET WITH:	Ephantus Warui, Administrator		TIME COMPLETED:	03:51 PM

ALLEGATION(S):

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-Staff are not trained
-Staff do not have a working thermometer

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-20200330135256. Today’s visit was conducted via tele visit due to COVID-19 precautionary measures.
During the course of this investigation, LPA Quiroz conducted interviews, reviewed documents including but not limited to inservice form dated 3/12/2020 and invoice receipt dated 3/17/2020.
During the course of the investigation it was concluded that five staff who are employed at the facility as medication technicians and front desk receptionists received training from Administrator Ephantus Warui on 3/12/2020. Documents reviewed verified five staff in attendance during the in service training for the topic: Thermometer held on 3/12/2020 at 2:00pm.
LPA Quiroz reviewed and observed invoice receipt with a purchase for “leader touch-free infrared Forehead thermometer” purchased on 3/17/2020 in the amount of $30.00 from Excelcare Pharmacy.
CONTINUED ON NEXT 9099-C PAGE...

Unfounded

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: 07/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2020

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-20200330135256

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: 07/07/2020

NARRATIVE

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Interviews with interviewees concluded there are two working thermometers at the facility. Interviewees reported there is one thermometer kept in the medication room, and one in the front desk to screen incoming essential visitors.
This agency has investigated the complaint alleging "Staff are not trained," and “Staff do not have a working thermometer.” The allegations "Staff are not trained" and “Staff do not have a working thermometer” are found to be UNFOUNDED. We have found that the allegations are unfounded, meaning that the allegations were false, could not have happened and/or are without a reasonable basis.

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: 07/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2020

LIC9099 (FAS) - (06/04)

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