306004415-8-2-2022-22-AS-AORZ-CJ8RMS-20220913130912

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004415
Report Date: 08/02/2022
Date Signed: 08/02/2022 02:12:40 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
07/27/2022 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220727085853

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: 139	DATE:	08/02/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Ephantus Warui, Administrator		TIME COMPLETED:	12:08 PM

ALLEGATION(S):

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Licensee issued an unlawful eviction

INVESTIGATION FINDINGS:

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On today's date, Licensing Program Analyst (LPA) Rosie Quiroz was greeted, COVID-19 screened by Front Desk Receptionist and granted entry. LPA Quiroz met with Administrator Ephantus Warui, and discussed the purpose of today's visit to address the allegation listed above.
During today's visit, LPA Quiroz conducted interviews with interviewees. During the course of the investigation the following was reviewed: Eviction notice dated 6/17/2021, and Resident 1(R1) R1's Physician Report. Three of three Interviewees interviewed, including R1, corroborated that the Licensee did not issue an unlawful eviction to R1.
Administrator Warui indicated that a 30 day notice to cure or terminate was issued to R1 on 6/17/2021 personally. Administrator Warui indicated that Licensee attempted to work out several payment catch up plans with R1; however R1 refused to work out a payment plan and maintain current. Administrator indicated the Health and Safety of the residents was Licensee's priority during the Pandemic.
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: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

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-20220727085853

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: 08/02/2022

NARRATIVE

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CONTINUED...

LPA Quiroz interviewed R1, who reported she was provided with an eviction notice on 6/17/2021 and an unlawful detainer on May 22, 2022 indicating understanding reason for eviction due to non payment since September 2020.

Based on the evidence gathered from interviews and a review of pertinent documentation, allegation of "Licensee issued an unlawful eviction" is deemed Unfounded, meaning that the allegation was false, could not have happened ad/or is without a reasonable basis; Therefore complaint is dismissed.

An exit interview was conducted, and a copy of this report along with LIC 811- Confidential Names list was provided to Administrator Warui at exit.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

LIC9099 (FAS) - (06/04)

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