306005901-12-13-2023-22-AS-SSAS-CYY33L-20231228165337

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005901
Report Date: 12/13/2023
Date Signed: 12/13/2023 04:12:38 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
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:	12:41 PM
MET WITH:	Eric Jensen - Executive Director		TIME COMPLETED:	02:29 PM

ALLEGATION(S):

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Staff do not meet residents' incontinence needs
Staff do not meet residents' grooming needs

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 denied both allegations.

Regarding incontinence needs, staff members interviewed claimed caregivers check resident’s every two hours. Staff 3 (S3) claims residents are checked and if they’re wet, they’re changed. Even when the resident is aggressive with the staff, back up staff will be called to assist the caregiver so the resident can be changed. According the S5, caregivers check the residents every two hours and it’s documented on the “Quick Mar” system. All the residents are available on the Quick Mar. Incontinence care, grooming, and activities are tracked for each resident daily through the Quick Mar system.
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: 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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As the caregivers complete a specific task the Quick Mar is updated. According to S5, the Quick Mar can be reviewed by managers and directors to ensure completion of the task and managers and directors are notified when resident ADL's are not completed. During a tour of the facility, S5 showed LPA Haley the Quick Mar and one of the computers the caregivers use to update the system.

Regarding the residents grooming needs, all the staff interviewed confirmed caregivers are responsible for the resident’s grooming needs. S5 confirmed groom is documented in the Quick Mar system, that monitors the residents ADL’s .

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: 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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