306004415-3-14-2023-22-AS-AORZ-CQ4QZ7-20230320123613

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004415
Report Date: 08/31/2022
Date Signed: 03/14/2023 02:48:04 PM

Unfounded

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
02/08/2021 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210208151131

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: 139	DATE:	08/31/2022
		UNANNOUNCED	TIME BEGAN:	01:16 PM
MET WITH:	Ephantus Warui, Administrator		TIME COMPLETED:	02:28 PM

ALLEGATION(S):

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-Facility staff is not providing an appropriate variety of foods for residents in care
-Facility serves cold food
-Resident was not provided a rent increase letter

INVESTIGATION FINDINGS:

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On today's date, Licensing Program Analyst (LPA) Rosie Quiroz was greeted, COVID-19 screened by Front Desk Receptionist and granted entry. LPA Quiroz met with Administrator Ephantus Warui, and discussed the purpose of today's visit to deliver findings regarding the allegations listed above.The initial 10-day was completed on 2/17/2021 by LPA Lydia Martinez virtually due to COVID-19 precautionary measures.
On today's date, LPA Quiroz along with (AD) Ephantus Warui conducted a facility inspection tour. While touring the facility, LPA Quiroz observed resident's having an outdoor luau luncheon. Luau luncheon consisted of: BBQ Beef brisket, BBQ Chicken, roasted chicken, macaroni salad, egg rolls, corn on the cobb, upside down pineapple cake, fresh fruit tray, and beverage of resident's choice. LPA Quiroz observed residents in courtyard area appearing to look content enjoying their luau luncheon and listening to music with ample staff supervision. During today's facility inspection, LPA Quiroz conducted interviews with eight residents in the court yard area.
It was alleged that "Facility staff is not providing an appropriate variety of foods for residents in care,"Facility serves cold food," and "Resident was not provided a rent increase letter." CONTINUED...
***THIS IS AN AMENDED REPORT***

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: 08/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022

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-20210208151131

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: 08/31/2022

NARRATIVE

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CONTINUED...
During the course of the investigation, LPA Quiroz reviewed documents but not limited to the following for Resident 1(R1) - Resident 8 (R8) : Physician reports and Identification Forms and rent increase letter dated 9/11/2020 for (R1).
Regarding the allegation "Facility staff is not providing an appropriate variety of foods for residents in care" and "Facility serves cold food," eleven of eleven interviewees consisting of staff and residents denied the allegations and did not corroborate indicating the variety of food at the facility has improved as evidenced by that on today's unannounced visit, the facility provided residents with a BBQ luncheon. Eleven of Twelve interviewees indicated the hot meals are served within good temperature. Eleven of twelve interviewees indicated that despite the challenges with the COVID pandemic, that staff has been working hard to make sure warm/hot meals are being delivered to residents timely.
It was alleged that "Resident was not provided a rent increase letter." On 4/13/2021, LPA Quiroz interviewed Resident 1(R1) via telephone due to COVID-19 precautionary measures, (R1)indicated "Yeah, now that I remember I did receive the letter. I found it in my dresser." LPA Quiroz verified with (R1) that the letter in possession of (R1) dated 9/11/2020 read the same as the one that was provided and reviewed by LPA Quiroz.

This agency has found the complaint allegations of "Facility staff is not providing an appropriate variety of foods for residents in care,"Facility serves cold food," and "Resident was not provided a rent increase letter" are deemed UNFOUNDED; Meaning that the allegations were false, could not have happened or are without a reasonable basis. We have therefore dismissed the complaint allegations listed above.

No deficiencies noted during today's visit. An exit interview was conducted with (AD) Ephantus Warui. A copy of this report and LIC 811- Confidential Names were provided at exit.

***THIS IS AN AMENDED REPORT***

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022

LIC9099 (FAS) - (06/04)

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