306005901-11-16-2023-22-AS-SSAS-CYGQWG-20231213113156

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005901
Report Date: 11/16/2023
Date Signed: 11/16/2023 04:28:56 PM

Unsubstantiated

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
03/06/2023 and conducted by Evaluator Jerome Haley

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230306125953

FACILITY NAME:	BEACH TERRACE MEMORY CARE		FACILITY NUMBER:	306005901
ADMINISTRATOR:	EDWARDS, CYNTHIA		FACILITY TYPE:	740
ADDRESS:	12282 BEACH BOULEVARD		TELEPHONE:	(503) 675-3925
CITY:	STANTON	STATE: CA	ZIP CODE:	90680
CAPACITY:	120	CENSUS: 47	DATE:	11/16/2023
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Eric Jensen		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Staff made resident lie on floor for discipline
Staff did not respond to a resident's needs timely
Staff speak inappropriately to residents in care

INVESTIGATION FINDINGS:

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LPA Haley made an unannounced visit to deliver the findings on the complaint allegations above. LPA Haley was greeted by staff and explained the reason for the visit.

Regarding the allegation: Staff made resident lie on floor for discipline.

During the investigation interviews were conducted with facility staff, family members of Resident 1 (R1), and hospice employees. 5 staff members acknowledged R1 was placed on the floor, but denied it was for discipline. Staff 1 (S1) stated R1 is a fall risk and has asked to be placed on the floor, so the resident doesn’t fall. Staff 5 (S5) says R1 gets agitated and will request to be placed on the floor, and said R1’s family, the son, and hospice are aware and it’s in the care plan. 2 members of R1’s family and 2 hospice employees denied seeing R1 on the floor. However, both family members and both hospice employees denied R1 could requested to sit on the floor.
Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

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-20230306125953

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: BEACH TERRACE MEMORY CARE	FACILITY NUMBER: 306005901
	VISIT DATE: 11/16/2023

NARRATIVE

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According to one of R1’s family members, R1 was mute and could not form a complete sentence, and according to one of the hospice employees R1’s responses were not reasonable or appropriate, you could tell R1 had cognitive issues.

Regarding the allegation: Staff did not respond to a residents needs timely

6 of 11 individuals denied the allegation. According to Staff 1, the caregivers go above and beyond when providing care to the residents in the community. Staff 4 says the staff are trying to pick up the speed of things and there’s a lot of training provided. 2 of R1’s family members had concerns about the care being provided but said the care for the resident improved once the resident was placed on hospice.

Regarding the allegation: Staff speak inappropriately to residents in care

All 6 staff members interviewed denied the allegation above. 2 family members of R1 and 2 hospice employees were unable to corroborate the allegation above. During interviews, Staff 5 says the residents are happy and there are no issues.

Based on the information gathered during the investigation through interviews and document review, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, all allegations are deemed Unsubstantiated.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

LIC9099 (FAS) - (06/04)

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