306004415-10-6-2023-22-AS-AORZ-CWKQUW-20231013122924

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004415
Report Date: 10/05/2023
Date Signed: 10/06/2023 09:06:48 AM

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
09/16/2020 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200916161208

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: 144	DATE:	10/05/2023
		UNANNOUNCED	TIME BEGAN:	12:47 PM
MET WITH:	Ephantus Warui, Administrator		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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-Facility does not maintain a comfortable temperature
-Resident inappropriately touching another resident while in care
-Resident going through another residents belongings
-Resident's medication went missing

INVESTIGATION FINDINGS:

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On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit for the purpose to deliver findings for the complaint investigation allegations listed above. LPA Quiroz completed the initial 10-day tele visit on 9/22/2020 due to COVID-19 precautionary measues, and conducted an investigation follow up visit on 3/7/2023.
During the course of this investigation, LPA Quiroz conducted interviews consisting of residents and staff, conducted facility observations and reviewed documents but not limited to: Physician reports, Identification forms, Staff Roster, Facility Roster and Fountain Valley Police Department Incident Reports dated 9/17/2020 and12/6/2022.
Regarding the allegation "Facility does not maintain a comfortable temperature," the investigation revealed the following: While LPA Quiroz conducted a facility inspection visit to address complaint control #22-AS-20220906160601 on 9/7/2022, LPA Quiroz conducted interviews with interviewees consisting of staff and residents. Eight of eight interviewees indicated "Facility has purchased portable air conditioners and began to install them early September 2022." CONTINUED ON NEXT LIC 9099-C 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: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

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-20200916161208

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: 10/05/2023

NARRATIVE

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CONTINUED...On 9/7/2022, Administrator Ephantus Warui indicated "We have also purchased black out curtains and maintenance has been installing them also, and will continue to install them where sun hits directly." During inspection visit on 9/7/2022, LPA Quiroz observed maintenance Director installing new portable air conditioners throughout the facility. On 9/7/2022, LPA Quiroz recorded the first floor indoor facility temperature to be between 75 degrees to 81 degrees fahrenheit. The second floor inspected areas were recorded to be between 72 degrees to 82 degrees fahrenheit. The outdoor temperature on 9/7/2022 in city of Fountain Valley, CA was recorded to be 100 degrees Fahrenheit. During facility inspection visit on 3/7/2023, the Indoor facility temperature was recorded to be between 72 degrees to 78 degrees Fahrenheit.
On today's date, the facility temperature throughout the facility was recorded to be between 78 degrees to 80 degrees Fahrenheit.
Regarding the allegation,"Resident inappropriately touching another resident while in care," the investigation revealed the following: Three of three interviewees reported Resident 2 (R2) had been out of the facility for few days due to hospitalization. Three of three interviews indicated "(R2) left to the hospital from 9/10/2020- 9/15/2020 and returned back to the hospital on 9/16/2020. Three of three interviewees indicated closely monitoring Resident (R1) and (R2) while in care indicating not being in close proximity while in care. Fountain Valley Police Department (FVPD) Incident Report dated 9/17/2020 indicated unknown date of incident occurence also indicating (FVPD) Officer was not able to speak to (R1) due to (R1) refusing to speak to (FVPD) Officer. (R1) moved out from Seaside Terrace Retirement Community on 11/14/2021 due to higher level of care needs. (FVPD) incident Report dated 12/6/2022 indicates (FVPD) officer attempted to interview (R1) at current residence; however (R1) continued to refuse to speak to (FVPD) Officer.
Regarding the allegation, "Resident going through another residents belongings," the investigation revealed the following: Three of three interviewees reported Resident 2 (R2) had been out of the facility for a few days due to hospitalization. Three of three interviewees indicated "(R2) left to the hospital from 9/10/2020- 9/15/2020 and returned back to the hospital on 9/16/2020. Three of three interviewees indicated closely monitoring Resident (R1) and (R2) indicating not being in close proximity while in care. Three of three interviewees indicated that only the facility Administrator has the key to (R1's) bedroom area. (AD) Warui indicated "(R2) requested to move bedrooms on 7/2/2020 and no longer shared a bedroom with (R1) effective 7/2/2020."
(AD) Warui indicated "At that time, I collected the key from (R2) and (R2) no longer had access to (R1)s bedroom area."
CONTINUED ON NEXT LIC 9099-C PAGE...

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20200916161208

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: 10/05/2023

NARRATIVE

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CONTINUED... Regarding the allegation "Resident's medication went missing," the investigation revealed the following: (R1)s physician report dated 6/6/2019 page 4 section 16 indicates (R1) is able to manage and store their own medications. Three of three interviewees indicated (R1) had their own private bedroom effective 7/2/2020 and stored their own medications in a locked secured locked box and was the only person with key to locked box. Three of three interviewees indicated (R1) would store their own key to the locked box on a lanyard around (R1s) neck area.

This agency has found the complaint allegations of "Facility does not maintain a comfortable temperature,"
"Resident inappropriately touching another resident while in care," "Resident going through another residents belongings," and Resident's medication went missing 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 citations cited during today's visit.

An exit interview was conducted with Administrator Ephantus Warui and a copy of this report and LIC 811-Confidential Names were 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: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

LIC9099 (FAS) - (06/04)

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