306004415-8-9-2023-22-AS-AORZ-CV6S2A-20230829132911

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004415
Report Date: 08/09/2023
Date Signed: 08/09/2023 04:33:09 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
03/25/2022 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220325093138

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: 145	DATE:	08/09/2023
		UNANNOUNCED	TIME BEGAN:	08:48 AM
MET WITH:	Ephantus Warui, Administrator		TIME COMPLETED:	10:50 AM

ALLEGATION(S):

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-Facility does not have sufficient staff to meet the resident's needs.
-Facility is not meeting resident's hygiene needs on a timely basis.

INVESTIGATION FINDINGS:

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On today's date, Licensing Program Analyst (LPA) Rosie Quiroz made an unannounced visit for the purpose to deliver findings for complaint allegations listed above. LPA Quiroz was greeted by Front Desk Receptionist and met with Administrator (AD) Ephantus Warui and discussed purpose of today's visit.
During the course of the investigation, LPA Quiroz conducted 10 day visit on 3/30/2023, conducted complaint follow up inspection visits on 9/22/2022 and 3/30/2023 and conducted interviews with fourteen interviewees consisting of residents, staff and other witnesses.
Regarding the allegations: "Facility does not have sufficient staff to meet the resident's needs," and "Facility is not meeting resident's hygiene needs on a timely basis," the investigation revealed the following: Seven of fourteen interviewees indicated there is sufficient amount of staff to meet the resident's overall needs on a timely basis. Seven of fourteen interviewees stated that the pandemic caused short staffing due to mandated isolation orders and personal leaves indicating that to date facility is still short staffed at times resulting in delay of showers, hygiene needs and other activities of daily living. Seven of fourteen interviewees indicated needs are being met, but not timely as evidence by moving showers over to the following day due to short staffing. CONTINUED...

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: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

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-20220325093138

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: 08/09/2023

NARRATIVE

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CONTINUED...

Therefore based on the preponderance of evidence gathered through interviews conducted with interviewees consisting of staff, residents, witnesses and observations conducted by LPA Quiroz, the allegations that the "Facility does not have sufficient staff to meet the resident's needs," and "Facility is not meeting resident's hygiene needs on a timely basis" are UNSUBSTANTIATED meaning although the allegations may have happened or are valid, however there is no preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. This agency has investigated the complaint.

No deficiencies cited during today's visit.

An exit interview was conducted with Administrator Ephantus Warui and a copy of 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: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

LIC9099 (FAS) - (06/04)

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