306005901-1-9-2024-22-AS-SSAS-CZQTH8-20240122134417

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005901
Report Date: 01/09/2024
Date Signed: 01/09/2024 12:03:21 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
10/16/2023 and conducted by Evaluator Jerome Haley

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20231016115710

FACILITY NAME:	BEACH TERRACE MEMORY CARE		FACILITY NUMBER:	306005901
ADMINISTRATOR:	ERIC JENSEN		FACILITY TYPE:	740
ADDRESS:	12282 BEACH BOULEVARD		TELEPHONE:	(503) 675-3925
CITY:	STANTON	STATE: CA	ZIP CODE:	90680
CAPACITY:	120	CENSUS: 48	DATE:	01/09/2024
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Eric Jensen - Executive Director		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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A lack of supervision resulted in a resident being assaulted by other residents while in care.
Staff are not properly reporting all incidents.
Staffing is insufficient in quantity to meet residents needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to the facility to deliver the findings on the complaint allegations above. LPA Haley was greeted by staff and explained the reason for the visit.
The complaint investigation consisted of a review of incident reports, facility notes, interviews with facility residents, facility staff, family members, witnesses, and observations.

Regarding the allegation: A lack of supervision resulted in a resident being assaulted by other residents while in care.
0 of 11 individuals could provide evidence to support the complaint allegation. During the investigation it was discovered that Resident 1 (R1) was involved in altercations with other residents. According to facility staff, when residents are involved in an altercation, the residents are separated, isolated, and the family and physicians are notified.
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: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

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-20231016115710

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: 01/09/2024

NARRATIVE

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A review of the incident reports involving R1 revealed facility staff was present to witness the altercation or present immediately after the incident to separate the residents and help resolve the issue and calm the residents down. Staff will also try to figure out what triggered the incident to prevent altercations in the future.
Regarding the allegation: Staff are not properly reporting all incidents.

0 of 11 individuals could provide evidence to support the allegation, and family members of R1 shared information that contradicts the complaint allegation. Family members of R1 confirmed the family was contacted by facility staff several times regarding altercations with other residents. A review of incident reports and charting notes show incidents involving resident altercations were documented, incident reports were written, and the incidents were reported to facility managers, residents’ family, and physicians. During interviews with facility staff members, they all confirmed they document the incident and notify appropriate parties including family and physicians.

Regarding the allegation: Staffing is insufficient in quantity to meet residents needs.

During an interview with a facility staff member, it was discovered the facility is fully staffed. 6 caregivers and 2 med tecs are scheduled to work the AM and the PM shifts. During the overnight shifts, 4 caregivers and 1 med tech is scheduled to work. Staff are responsible for providing care for all residents, if it’s discovered a resident needs more care due to their behavior or additional care needs, Beach Terrace will contact the family to discuss additional care options for that resident including one-to-one care. During interviews with staff, it was discovered care staff will immediately separate residents involved in a conflict, staff will keep the residents away from each other, and if a resident continues to have altercations with peers the resident’s physician will be notified.

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

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: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

LIC9099 (FAS) - (06/04)

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