306004415-4-1-2021-22-AS-AORZ-BZWVV7-20210409164549

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004415
Report Date: 04/01/2021
Date Signed: 04/01/2021 03:57:44 PM

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
04/07/2020 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200407135242

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:	ZIP CODE:	92708
CAPACITY:	250	CENSUS: 137	DATE:	04/01/2021
		UNANNOUNCED	TIME BEGAN:	03:12 PM
MET WITH:	Ephantus Warui, Administrator		TIME COMPLETED:	03:53 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

-Trash were piling up
-Rats and cockroaches were observed inside the facility.
-Facility had no hot water.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

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 tele visit was completed on 4/09/2020. During the initial 10 day visit, LPA Quiroz toured the facility along wtih Administrator Ephantus Warui virtually due to COVID-19 Precautionary measures.
During the course of this investigation, LPA Quiroz conducted interviews, reviewed documents including but not limited to Republic Sevices invoice and Pro effect pest management invoice and Monthly pest management inspection log reflecting monthly inspection visits in random room numbers.
During initial 10 day tele visit conducted on 4/9/2020, LPA Quiroz observed 2 trash waste bins. 2 of 2 trash bins were observed to not be overflown with trash and no trash was observed on the floor near trash bin area.
During a follow up interview with Administrator Ephantus Waui, LPA Quiroz obtained pictures of trash waste bins observations conducted on 4/9/2020. 8 of 8 interviewees denied allegation of "Trash were piling up."
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: 04/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2021

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-20200407135242

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: 04/01/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

During interview conducted on 4/9/2020, complainant stated "I never complained about the trash. Maybe someone else, not me."

It was alleged that "Rats and cockroaches were observed inside the facility."During the course of this investigation, LPA Quiroz conducted interviews with interviewees, reviewed documents including but not limited to Pro effect pest management service contract which commenced on 1/12/2015, and monthly pest inspections conducted in the facility in random room numbers. Administrator Warui stated, "We have Monthly pest management inspections and haven't had any pest complaints from residents or staff in a very long time. It's improved a lot."
8 of 8 interviewees denied allegations. During interview conducted with complainant on 4/9/2020, Complainant stated "I didn't complaint about cockroaches. Maybe it was someone else. Not me."

It was alleged that “Facility had no hot water.” During the course of the investigation, LPA Quiroz conducted multiple interviews with interviewees, and observations conducted by LPA Quiroz during initial 10 day televisit conducted on 4/9/2020. On 4/9/2020, LPA Quiroz virtually 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 116.9 degrees Fahrenheit. 8 of 8 Interviewees denied allegations that "Facility had no hot water." with statements as "It used to be an issue, but not lately." During interview with complainant on 4/9/2020, Complainant stated "I never complained about the hot water. Maybe it was someone else, not me."

This agency has found the complaint allegations of "Facility had no hot water," "Trash were piling up," and
"Rats and cockroaches were observed inside the facility" 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.

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: 04/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2