306005901-12-13-2023-22-AS-SSAS-CYY33K-20231228165336

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005901
Report Date: 12/13/2023
Date Signed: 12/13/2023 04:11:45 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
12/28/2022 and conducted by Evaluator Jerome Haley

COMPLAINT CONTROL NUMBER: 22-AS-20221228161711

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:	12/13/2023
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Eric Jensen - Executive Director		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Staff do not provide activities for the residents
Staff did not provide resident with linen

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jerome Haley made unannounced visit regarding the complaint allegations above. LPA Haley was granted entry and explained the reason for the visit with upon entry. During the visit LPA Haley conducted interviews with four residents, and 1 additional staff member Staff 5 (S5) to gather additional information.

Regarding the allegations above, during the investigation 6 of 7 staff members confirmed activities are scheduled throughout the day and activities start around 9:30AM after breakfast. According to Staff 3 (S3) one activity residents play is Senior Volleyball with a balloon. During an interview with Staff 2 (S2) who was the activity’s coordinator at the time explained, residents participate in various activities like stretching, coloring, cornhole, bowling, and a laundry activity. LPA Haley was provided a copy of the activities calendar for various months. During interviews it was discovered residents can also sing and dance if they like. While visiting the facility for matters unrelated to this complaint, LPA Haley has observed residents taking part in activities just about every visit.
Continued on LIC9099C

Unfounded

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: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

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-20221228161711

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: 12/13/2023

NARRATIVE

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Residents are separated into two different groups. Residents who are more active are separated from residents who are not as active. The active residents take part in activities like exercising or balloon toss while the group with the less active residents sit at the table and participate in sensory activities like coloring or a laundry activity.

Regarding clean linen. 6 staff members confirmed residents are provided clean linen daily. Residents keep their clean linen in their room. According to Executive Director Jensen, linen is monitored daily, and families are told to bring more than one set of linen for the residents. According to Staff 1 (S1), if a resident doesn’t have an extra set of linens, the soiled linen is removed and cleaned immediately. During an interview with Staff 5 (S5) it was confirmed laundry is done daily and if a resident’s linen is soiled it’s cleaned the same day. S5 lead LPA Haley on a tour of the laundry room and during the tour of the laundry room, washer machines were in use.

Based on the information gathered during the investigation through interviews, document review, and observation, the allegations mentioned above are deemed UNFOUNDED, meaning the allegations are false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted, and a copy of this report was provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

LIC9099 (FAS) - (06/04)

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