306004415-10-14-2020-22-AS-AORZ-BUFSN3-20201016140052

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004415
Report Date: 10/14/2020
Date Signed: 10/14/2020 11:27:29 AM

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
03/13/2020 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200313141202

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: 140	DATE:	10/14/2020
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Ephantus Warui, Administrator		TIME COMPLETED:	10:54 AM

ALLEGATION(S):

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-Residents have not had a shower in a week
-Facility had a power outage resulting in oxygen tanks not working
-Facility fire alarm system does not work properly

INVESTIGATION FINDINGS:

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On today's date, Licensing Program Analyst (LPA) Rosie Quiroz contacted Administrator Ephantus Warui for the purpose to deliver findings for a complaint investigation via telephone due to COVID-19 and pre-cautionary measures.
The initial 10-day visit was completed on 3/20/2020. During the initial 10 day visit, LPA Quiroz obtained copies of Resident Roster, Staff Roster, City of Fountain Valley Fire Department Permit issued on 2/1/2020 with expiration date of 1/31/2021. During a follow up interview with Administrator Warui, LPA Quiroz obtained resident showering schedules.
It was alleged that “Facility had a power outage resulting in oxygen tanks not working.” During the course of this investigation, LPA Quiroz conducted multiple interviews with interviewees, reviewed documents including but not limited to staff schedules, staff roster, virtual tour tele visit inspection observations conducted on 3/20/2020 , City of Fountain Valley Fire Department Permit issued on 2/1/2020 with expiration date of 1/31/2021 and resident showering schedules. CONTINUED ON NEXT 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: 10/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2020

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-20200313141202

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: 10/14/2020

NARRATIVE

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CONTINUED...During the unannounced 10-day virtual tour inspection on 3/20/2020, LPA Quiroz observed 3 of 3 random oxygen tanks functional and operational and turned on. In addition, during virtual tele visit on 3/20/2020, LPA Quiroz observed lamps turned on, televisions turned on, and other electrical appliances turned on. Eight of eight interviewees denied allegations of “Facility had a power outage resulting in oxygen tanks not working.” Based on a review of the above information, observations and interviews conducted, we have found the complaint allegation of "Facility had a power outage resulting in oxygen tanks not working" is deemed UNFOUNDED; Meaning that the allegation was false, could not have happened or is without a reasonable basis. We have therefore dismissed the complaint.
It was alleged that “Residents have not had a shower in a week." During the course of the investigation, LPA Quiroz conducted multiple interviews with interviewees, reviewed documents but not limited to staff roster, staff schedule, virtual tele visit observations conducted during virtual inspection on 3/20/2020 and resident showering schedules. Seven of eight interviewees denied allegations that “Residents have not had a shower in a week.” One of eight interviewees reported not receiving their scheduled shower on scheduled date due to their own preference and later throughout interview stated “But, I do get it. Sometimes I just don’t want it when I’m supposed to get it.” Based on a review of the above information, observations and interviews conducted, we have found the complaint allegation of "Residents have not had a shower in a week" is deemed UNFOUNDED; Meaning that the allegation was false, could not have happened or is without a reasonable basis. We have therefore dismissed the complaint.
It was alleged that “Facility fire alarm system does not work properly.” During the course of the investigation, LPA Quiroz conducted multiple interviews with interviewees, reviewed documents but not limited to City of Fountain Valley Fire Department Permit issued on 2/1/2020 with expiration date of 1/31/2021 and virtual tele visit observations conducted during virtual inspection on 3/20/2020. Eight of eight interviewees denied allegations that “Facility fire alarm system does not work properly.” During virtual inspection visit on 3/20/2020, LPA Quiroz observed power outage panel and fire panel turned on, functional and operational. Based on a review of the above information, observations and interviews conducted, we have found the complaint allegation of "Facility fire alarm system does not work properly" is deemed UNFOUNDED; Meaning that the allegation was false, could not have happened or is without a reasonable basis. We have therefore dismissed the complaint.
An exit interview was conducted with Administrator Ephantus Warui via telephone and a copy of this report was provided via email. An electronic email read receipt, confirms receiving these documents. Administrator agreed to receive the copies of the report and to return a signed copy to Community Care Licensing and LPA Quiroz timely.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2020

LIC9099 (FAS) - (06/04)

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