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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005901
Report Date: 11/14/2024
Date Signed: 11/14/2024 06:32:43 PM

Substantiated


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
11/12/2024 and conducted by Evaluator Claudia Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20241112141855
FACILITY NAME:BEACH TERRACE ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
306005901
ADMINISTRATOR:ERIC JENSENFACILITY TYPE:
740
ADDRESS:12282 BEACH BOULEVARDTELEPHONE:
(530) 242-8300
CITY:STANTONSTATE: CAZIP CODE:
90680
CAPACITY:120CENSUS: 44DATE:
11/14/2024
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Dennis RobeniolTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Staff do not ensure call signal system is in good repair
Staff do not respond to residents in a timely manner
INVESTIGATION FINDINGS:
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An unannounced Complaint Investigation was conducted on this day regarding the allegations mentioned above by Licensing Program Analyst (LPA) Claudia Gutierrez. LPA met with Executive Director (ED) Dennis Rubeniol and explained the purpose of the visit.

Interviews were conducted with four facility staff regarding the allegation staff do not ensure call signal system is in good repair. Two of four staff interviewed stated the pull cord located in memory care residents’ bathrooms does not signal or alert staff in any way and the facility does not have a call signal system; if a resident needs assistance they must yell out for help or wait for staff to come and check on them by happenstance. One of four staff stated there is no call system for memory care residents living on the third floor, however assisted living residents on the second floor of the facility have a call button, but the call system does not identify the specific resident living unit and the auditory signal does not produce an auditory signal loud enough to summon staff. (Cont. LIC9099-C)
Substantiated
Estimated Days of Completion: 90
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia GutierrezTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 22-AS-20241112141855
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 ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 306005901
VISIT DATE: 11/14/2024
NARRATIVE
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One of four staff interviewed stated there is a call system for the assisted living residents on the second floor of the facility, but the call system does not identify the specific resident living unit.

Interviews were conducted with four staff regarding the allegation staff do not respond to residents in a timely manner. Two of four staff interviewed stated that because the facility does not have a call signal system, staff may not respond in a timely manner and were unable to indicate how long a resident must wait to be assisted. One of four staff interviewed stated that although assisted living residents on the second floor of the facility have a call button, the call system does not identify the specific resident living unit and the auditory signal does not produce an auditory signal loud enough to summon staff; therefore staff must be within proximity to hear the auditory signal located in the hallways of the second floor of the facility, which is not auditory from the dining room or residents’ living units. Once staff hear the auditory signal they must go room to room to identify the resident calling, which results in a delayed response time. One of four staff interviewed stated that although the call system for the assisted living residents on the second floor does not identify the specific resident living unit staff respond in “three to five minutes.”

Based on staff interviews conducted, LPA determined staff do not ensure call signal system is in good repair and staff do not respond to residents in a timely manner. The preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. Two deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted with Resident Care Director (RCD) Alysia Noriega, and a copy of this report and appeal rights was provided at the end today's inspection.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia GutierrezTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20241112141855
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 ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 306005901
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/15/2024
Section Cited
CCR
87303(a)
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(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents...

This requirement is not met as evidenced by:
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RCD stated an operational signal system will be put in place and proof provided to LPA via email by POC date.
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Based on staff interviews, the licensee did not comply with the section cited above as the facility does not have an operational call signal system in memory care, which poses an immediate health and safety risk to persons in care.
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Type A
11/15/2024
Section Cited
HSC
1569(c)
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"Care and supervision" means the facility assumes responsibility for, or provides... ongoing assistance with activities of daily living without which the resident’s... safety, or welfare would be endangered.

This requirement is not met as evidenced by:
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RCD stated a call system identifying residents' specific living units will be put in place and staff training conducted regarding the call system and staff response. RCD will provide LPA with proof via email by POC date.
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Based on staff interviews, the licensee did not comply with the section cited above as residents' are unable to alert staff for assistance from their specific living units, which poses a potential safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia GutierrezTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3