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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004415
Report Date: 11/28/2023
Date Signed: 11/28/2023 04:10:24 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
08/31/2023 and conducted by Evaluator Rosie Quiroz
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230831092348
FACILITY NAME:SEASIDE TERRACE RETIREMENT COMMUNITYFACILITY NUMBER:
306004415
ADMINISTRATOR:KAROLINA FILFACILITY TYPE:
740
ADDRESS:9925 LA ALAMEDA AVENUETELEPHONE:
(714) 962-5531
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:250CENSUS: 129DATE:
11/28/2023
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Ephantus Warui, AdministratorTIME COMPLETED:
04:14 PM
ALLEGATION(S):
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-Facility failed to ensure incontinence care was provided to residents
-Personal Rights violation
INVESTIGATION FINDINGS:
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 On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit for the purpose to conduct additional interviews and deliver findings for complaint allegations listed above. LPA Quiroz was greeted by Administrative Assistant Vanny Long, granted entry and met with Administrator (AD) Ephantus Warui and discussed purpose of today's visit. The 10 day visit was conducted on 9/05/2023 and a complaint follow up visit was conducted on 9/12/2023.
During the course of the investigation, LPA Quiroz conducted interviews with interviewees consisting of staff and residents. LPA Quiroz also conducted documentation review but not limited to resident roster, staff roster, physician reports, Needs and Services plans, identification forms and incontinence care logs for Memory Care Unit and Assisted Living area.
Regarding the allegation "Facility failed to ensure incontinence care was provided to residents," Four of four residents indicated incontinence care is being provided to residents in care. Four of Four staff denied the allegation indicating that staff are providing incontinence care to residents identified on incontinence care log.
CONTINUED ON NEXT LIC 9099-C PAGE...
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 22-AS-20230831092348
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: 11/28/2023
NARRATIVE
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CONTINUED...Eight of eight interviewees indicated that although facility has experienced staffing shortages due to recent staffing changes, that staff have been volunteering to working overtime to cover shifts and coordinating incontinence care for residents requiring incontinence care.
Regarding the allegation, "Personal Rights violation" interviews conducted with Eight of eight interviewees concluded that facility is primarily staffed with all female caregivers on the Assisted Living area on all three shifts. Four of four residents indicated that facility staff respect the resident's choice with caregiver preference when requested.
Therefore based on the preponderance of evidence gathered through interviews, documentation review and observations conducted by LPA Quiroz, the allegations that the "Facility failed to ensure incontinence care was provided to residents" and "Personal Rights violation" are deemed UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. This agency has investigated this complaint.
No deficiencies cited during today's visit.
An exit interview was conducted with (AD) Warui and a copy of report was provided at exit.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2