306005901-2-28-2024-22-AS-LMOA-D2X53N-20240229183614

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005901
Report Date: 02/28/2024
Date Signed: 02/28/2024 03:22:05 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
02/27/2024 and conducted by Evaluator Jerome Haley

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240227112730

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: 42	DATE:	02/28/2024
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Eric Jensen - Executive Director		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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The facility does not have insurance coverage.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jerome Haley made unannounced visit to start the investigation for a complaint received February 27, 2024. LPA Haley was greeted by staff and explained the reason for the visit.

Regarding the allegation: The facility does not have insurance coverage.
After a brief discussion with Executive Director Eric Jensen, it was discovered the facility has a valid insurance policy. The insurance policy was provided and reviewed during the visit. Upon review, it was discovered the insurance policy is current and meets regulation requirements.

Based on the information gathered through interview and document review, the following allegation: The facility does not have insurance coverage, is deemed unfounded, meaning the allegation is 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.

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: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

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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