306004415-8-14-2023-22-AS-AORZ-CVUJYL-20230920072805

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004415
Report Date: 08/09/2023
Date Signed: 08/14/2023 05:06:22 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
01/24/2023 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230124152358

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:	02:20 PM
MET WITH:	Ephantus Warui, Administrator		TIME COMPLETED:	04:55 PM

ALLEGATION(S):

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-Staff is using profanity around residents.
-Residents are smoking in their rooms.

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 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 2/22/2023, conducted complaint follow up inspection visit 3/7/2023 and conducted interviews with fourteen interviewees consisting of residents, staff and other witnesses,
Regarding the allegation "Staff is using profanity around residents," the investigation revealed the following: Seven of Fourteen interviewees denied the allegation, indicating Staff 1 (S1) does not use profanity around residents indicating "(S1) tends to use loud voice and has an energetic personality." Seven of fourteen interviewees corroborated with allegation stating "(S1) tends to use profanity around residents followed my immediately apologizing for use of their profanity around the residents," indicating (S1) is nice to residents and means no harm and is very helpful to residents as evidenced by...CONTINUED ON NEXT LIC 9099 C PAGE...***THIS IS AN AMENDED REPORT***

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-20230124152358

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...assisting them with making doctor's appointments and helping them with any needed tasks.
Regarding the allegation "Residents are smoking in their rooms," the investigation revealed the following: Five of Eight interviewees denied the allegation indicating residents smoke only in smoking area. Three of eight interviewees collaborated with the allegation as evidenced by stating "forgetting about having to go to smoking area to smoke sometimes." (AD) Warui indicated Assisted Living Waiver (ALW) Coordinators have conducted telephone calls to (ALW) recipients residing in the facility informing them about importance of not smoking in their bedrooms and consequences of breaking house rules and (ALW) Rules if continuing to smoke in non-smoking areas of the facility.
During inspection visits conducted by LPA Quiroz on 2/22/2023 and 3/7/2023 and 8/9/2023, identified smoking residents by facility were observed by LPA Quiroz to be smoking in smoking area.
Therefore based on the preponderance of evidence gathered through interviews and observations conducted by LPA Quiroz, the allegations that the "Staff is using profanity around residents," and "Residents are smoking in their rooms," are UNSUBSTANTIATED meaning that although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

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.

***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: 08/09/2023

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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