306004415-8-31-2022-22-AS-AORZ-CKTUYE-20221103155946

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004415
Report Date: 08/31/2022
Date Signed: 08/31/2022 02:07:51 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
08/19/2020 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200819172436

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:	08/31/2022
		UNANNOUNCED	TIME BEGAN:	11:59 AM
MET WITH:	Ephantus Warui, Administrator		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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-Inadequate food portions
-Food is being served cold

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 deliver findings regarding the allegations listed above.The initial 10-day tele visit was completed on 8/25/2020 due to COVID-19 precautionary measures.
On today's date, at 12:05pm, LPA Quiroz along with (AD) Ephantus Warui conducted an interior facility inspection tour. While touring the facility, LPA Quiroz observed resident's having an outdoor luau luncheon. Luau luncheon consisted of: BBQ Beef brisket, BBQ Chicken, roasted chicken, macaroni salad, egg rolls, corn on the cobb, upside down pineapple cake, fresh fruit tray, and beverage of resident's choice. LPA Quiroz observed resident's enjoying their luau luncheon and listening to music in outdoor courtyard area with staff supervision. Resident's in attendance appeared to be content. On today's date, LPA Quiroz interviewed seven (7) interviewees.

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: 08/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022

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-20200819172436

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: 08/31/2022

NARRATIVE

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It was alleged that facility is serving "Inadequate food portions." and "Food is being served cold."
During the course of this investigation, LPA Quiroz conducted interviews with eleven (11) interviewees, reviewed documents including but not limited to: physician reports, needs and services plans, identification forms and conducted 3 in person facility inspections on the following dates: July 18, 2022, August 2, 2022 and August 31, 2022.

During the course of the investigation while conducting complaint follow up visits for the following complaints: 22-AS-20200629114611 and 22-AS-20220727085853 on July 18, 2022, August 2, 2022 and on today's date LPA Quiroz observed food being served to be adequate food portions and interviews with eleven of eleven interviewees reported " food not being cold."11 of 11 interviewees denied two of two allegations.

This agency has found the complaint allegations of " Inadequate food portions," and "Food is being served cold" 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.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022

LIC9099 (FAS) - (06/04)

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