306004415-2-22-2023-22-AS-AORZ-CQ4QZ6-20230320123613

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004415
Report Date: 02/22/2023
Date Signed: 02/22/2023 04:41:28 PM

Unsubstantiated

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:	02/22/2023
		UNANNOUNCED	TIME BEGAN:	09:47 AM
MET WITH:	Ephantus Warui, Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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-Residents left in soiled diapers due to insufficient staffing

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 regarding allegation listed above.The initial 10-day visit 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. During today's visit, LPA Quiroz observed resident's participating in Activity Room, Television room, lobby area, and in their bedrooms resting. On today's date, LPA Quiroz interviewed ten (10) interviewees consisting of staff and residents.
It was alleged that "Residents left in soiled diapers due to insufficient staffing." During the course of this investigation, LPA Quiroz conducted interviews with 10 interviewees consisting of residents and staff, reviewed documents including but not limited to: physician reports, needs and services plans, identification forms and conducted 3 in person facility inspection visits on the following dates: 8/15/2022, 8/31/2022 and 2/22/2023.
CONTINUED ON NEXT PAGE...

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: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

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: 02/22/2023

NARRATIVE

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CONTINUED...During the course of the investigation, 5 of 10 interviewees corroborated with the allegation indicating there were staff shortages during the COVID-19 pandemic created staffing challenges. During the course of the investigation 5 of 10 interviewees denied the allegations indicating sufficient amount of staff due to facility staff working overtime to cover shifts and facility staff using agency staff when staff called out due to isolation protocol per Community Care Licensing and Orange County Public Health.
Based on a review of the documentation but not limited to night shift rotation logs, staffing schedules, observations and interviews conducted with interviewees consisting of staff and residents; We have found the complaint allegation of "Residents left in soiled diapers due to insufficient staffing," is deemed UNSUBSTANTIATED; meaning 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.

No deficiencies noted during today's visit. An exit interview was conducted with (AD) Ephantus Warui. A copy of this report was provided at exit.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC9099 (FAS) - (06/04)

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