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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005901
Report Date: 01/30/2025
Date Signed: 01/30/2025 03:53:52 PM

Unsubstantiated


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
01/21/2025 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250121104701
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:
01/30/2025
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Dennis RobeniolTIME COMPLETED:
01:14 PM
ALLEGATION(S):
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Staff do not ensure residents care plans is being followed
INVESTIGATION FINDINGS:
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Regarding the complaint allegation: Staff do not ensure residents care plans is being followed

During the investigation 3 of 4 staff members were interviewed and provided evidence that contradicts the complaint allegation. In addition to interviews, documents relevant to the allegation above were provided and reviewed. During interviews, orders for two different creams (A&D Ointment & Lubriderm Daily Moisture Lotion) were provided for reviewed. In the order for A&D Ointment dated November 11, 2024, the A&D ointment is to be applied twice a day: 7:00am and 7:00pm. In a new order dated December 30, 2024, the A&D ointment is to be applied three times a day: 0800, 1500, and 2000. In addition to the physicians’ orders that were provided, medication administration records (MAR) were provided for R1, that show the creams were applied to the resident as prescribed. When the new order was provided for the A&D Ointment, the facility started applying the ointment as prescribed and the MAR reflects the change. Regarding R1’s compression socks, it was discovered R1 was ordered to wear the compression socks, but an ordered to discontinue the use of the compression socks for R1 was provided to the facility.
Continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
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 2
Control Number 22-AS-20250121104701
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: 01/30/2025
NARRATIVE
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The order to discontinue the use of the compression socks was dated May 4, 2024. During that time the compression socks were discontinued, R1’s legs were being treated and wrapped by home health. Recently, a new order was given to resume use of the compression socks dated January 21, 2025. At that time the facility began putting the compression socks on R1 according to physicians’ orders. During an interview with Staff 4 (S4) about the compression socks, it was explained that when staff remove the compression socks to apply the prescribed creams/ointments to R1’s legs, the resident will refuse to put the socks on because the residents tell staff there is too much pressure on their feet/toes. A photo was provided of R1 without compression socks, however it’s unclear if the resident refused to wear the socks at that time, and it’s also unclear if an order was in place at the time the resident was photographed without the compression socks on. Furthermore, Staff 1 (S1) member sent an email to R1’s family member requesting more clarification from the physician regarding when the compression socks should be put on and when they should be taken off.

Based on the information gathered through interviews, document review, and photo review, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated.

An exit interview was conducted and a copy of this repot was provided.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2