<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005901
Report Date: 12/24/2024
Date Signed: 12/24/2024 02:15:53 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
12/17/2024 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20241217175306
FACILITY NAME:BEACH TERRACE ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
306005901
ADMINISTRATOR:DENNIS ROBENIOLFACILITY TYPE:
740
ADDRESS:12282 BEACH BOULEVARDTELEPHONE:
(714) 694-3205
CITY:STANTONSTATE: CAZIP CODE:
90680
CAPACITY:120CENSUS: 45DATE:
12/24/2024
UNANNOUNCEDTIME BEGAN:
02:36 PM
MET WITH:Dennis RobeniolTIME COMPLETED:
02:37 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
The smell of urine was present in the facility.
Residents were left unsupervised.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Regarding the complaint allegation: Residents were left unsupervised.

During the investigation, 5 of 8 individuals interviewed denied the complaint allegation. However, during the initial complaint visit, December 18, 2024, about 15-20 residents were observed in a common area and the hallways of the third floor without supervision. Caregivers were observed in other rooms attending to other residents, but the residents who were up and waiting for breakfast were left unsupervised. During the investigation, interviews with other staff members confirmed they were short staffed during the initial visit due to two last minute call offs. During an interview with one of the staff members, it was confirmed residents were left unsupervised while the staff went to perform another task.

Regarding the complaint allegation: The smell of urine was present in the facility.

Continued on LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2024
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-20241217175306
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: BEACH TERRACE ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 306005901
VISIT DATE: 12/24/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
During the investigation, 7 of 8 individuals confirmed the smell of urine and/or feces in the facility. One of the staff members confirmed the smell and said, it’s coming from the third floor. A witness who was interviewed said, they told the staff about the smell already. The witness says they never experienced the facility smelling like this. LPA observations made during the initial visit December 18, 2024 confirm the complaint allegation.

Based on the evidence gathered through interviews, and observations the preponderance of evidence standard has been met, therefore, the above allegations are to be SUBSTANTIATED. Violations are being cited per California Code of Regulations Title 22.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20241217175306
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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: 12/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/26/2024
Section Cited
CCR
87464(f)(1)
1
2
3
4
5
6
7
87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision... This requirement was not met as evidenced by:

1
2
3
4
5
6
7
Executive Director Dennis Robeniol will send LPA Haley a detailed plan that will address staffing concerns. The plan will include actions the staff should take in the event there are multiple call offs during the shift. The plan to address staffing concerns is due by 1:00pm on the POC due date.
8
9
10
11
12
13
14
Based on LPA observation and interview confirmation, the licensee did not comply with the section cited above. On December 18, 2024 around 7:45 AM multiple residents were left alone on the third floor while staff performed other task. This poses an immediate safety risk to persons in care.
8
9
10
11
12
13
14
Type B
12/26/2024
Section Cited
CCR
87303(a)
1
2
3
4
5
6
7
87303 Maintenance and Operation
(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, employees and visitors.

1
2
3
4
5
6
7
The areas have been cleaned and disinfected. No further action necessary.
8
9
10
11
12
13
14
This requirement was not being met as evidenced by: The smell of urine/feces present in the facility that originated on the third floor. This poses a potential health risk to residents in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3