306004415-10-14-2020-22-AS-AORZ-BUFSN4-20201016140052

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004415
Report Date: 10/14/2020
Date Signed: 10/14/2020 11:29:34 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:	09:50 AM
MET WITH:	Ephantus Warui, Administrator		TIME COMPLETED:	10:08 AM

ALLEGATION(S):

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-There is not consistent hot water in the facility

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 "There is not consistent hot water in the facility." During the course of this investigation, LPA Quiroz conducted multiple interviews with interviewees, reviewed documents including but not limited to staff schedules, staff roster, and virtual tour tele visit observations conducted on 3/20/2020.

CONTINUED ON NEXT PAGE...

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: 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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During the unannounced 10-day virtual tour inspection on 3/20/2020, LPA Quiroz observed 6 of 6 water temperatures in various resident bathrooms ranging from first floor, second floor and communal resident bathroom with water temperatures recorded to be between 110.9 degrees Fahrenheit and 117.0 degrees Fahrenheit. Six of Eight Interviewees denied allegations that "There is not consistent hot water in the facility." Two of eight interviewees reported “That although the water temperature in the facility has improved; that there are days when there’s not hot water.” Two of eight interviewees were not able to specify approximate time of water temperature inconsistency.
Based on a review of the above information, observations and interviews conducted, we have found the complaint allegation of "There is not consistent hot water in the facility" is deemed UNSUBSTANTIATED; meaning although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

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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