306004415-8-22-2023-22-AS-AORZ-CWNQZV-20231016123719

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004415
Report Date: 08/22/2023
Date Signed: 08/22/2023 03:49:20 PM

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
11/18/2022 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20221118151035

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:	08/22/2023
		UNANNOUNCED	TIME BEGAN:	12:41 PM
MET WITH:	Ephantus Warui, Administrator		TIME COMPLETED:	03:48 PM

ALLEGATION(S):

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-Facility did not safeguard resident's personal belongings which resulted in theft.
-Facility staff do not treat resident with dignity and respect when speaking to them.

INVESTIGATION FINDINGS:

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On today's date, Licensing Program Analyst (LPA) Rosie Quiroz was greeted by Front Desk Receptionist and granted entry. LPA Quiroz met with Administrator (AD) Ephantus Warui, and discussed the purpose of today's visit. The initial 10-day inspection visit was completed on 11/28/2022 by LPA Quiroz.
It was alleged that "Facility did not safeguard resident's personal belongings which resulted in theft,"
During the course of the investigation, interviewee indicated locating missing cellphone in their dresser indicating "It was not stolen, I forgot where I had put it but I found it already."
Regarding the allegation, "Facility staff do not treat resident with dignity and respect when speaking to them," During the course of the investigation, LPA Quiroz conducted interviews with 8 interviewees consisting of staff and residents. Eight of eight interviewees denied allegation indicating facility staff treat residents with dignity and respect when speaking to the residents.
CONTINUED ON 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: 08/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

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-20221118151035

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: 08/22/2023

NARRATIVE

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CONTINUED...This agency has found the complaint allegations of "Facility did not safeguard resident's personal belongings which resulted in theft," and "Facility staff do not treat resident with dignity and respect when speaking to them,"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 deficiencies noted during today's visit. An exit interview was conducted with (AD) Ephantus Warui. 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: 08/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

LIC9099 (FAS) - (06/04)

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