306005901-4-3-2025-22-AS-MSTC-DG98EE-20250430222702

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005901
Report Date: 04/03/2025
Date Signed: 04/03/2025 04:40:07 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
03/27/2025 and conducted by Evaluator Jerome Haley

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20250327152606

FACILITY NAME:	BEACH TERRACE ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	306005901
ADMINISTRATOR:	DENNIS ROBENIOL		FACILITY TYPE:	740
ADDRESS:	12282 BEACH BOULEVARD		TELEPHONE:	(714) 694-3205
CITY:	STANTON	STATE: CA	ZIP CODE:	90680
CAPACITY:	120	CENSUS: 38	DATE:	04/03/2025
		UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Christine Chon		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Caregivers are sleeping during the night shift
Caregivers are not properly trained to provide care

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Jerome Haley made an unannounced visit regarding the complaint allegations above. LPA Haley was greeted by staff and explained the reason for the visit upon entry. During the visit LPA conducted interviews with residents, staff, reviewed documents, and made observations.

Regarding the allegation: Caregivers are sleeping during the night shift
During the investigation LPA Haley interviewed 6 individuals. 3 of 6 individuals acknowledged staff working on the night shifts are sleeping while on duty. During interviews, it was discovered a caregiver was inside a resident’s room for an extended period of time during the caregiver’s overnight shift. This was confirmed during interviews. It was also discovered, a facility staff member spoke to the caregiver about being in the resident’s room and told the caregiver that is not okay.

Although it is unclear if the staff member was sleeping or not sleeping, it was clear the staff member was in the residents room unauthorized which is a violation of the residents personal rights.
Continued on LIC9099C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) 703-2870
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025

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-20250327152606

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: 04/03/2025

NARRATIVE

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Regarding the allegation: Caregivers are not properly trained

During interviews it was discovered one of the facility residents has a colostomy bag and staff are draining and changing the colostomy bag several times a day, everyday. The staff member was asked if the staff have been trained by a qualified professional to perform maintenance of the colostomy bag, and the staff member was not sure. The same staff member was then asked if the resident was on Hospice or Home Health. The staff member said the resident was not on hospice and was not sure if the resident was on Home Health. During the interview, the staff member called another staff member via walkie talkie, and asked if the resident with the colostomy bag was on Home Health. The staff answered, no. Later on, during the investigation it was revealed the resident is indeed on Home Health.

A colostomy is an allowable health condition however, the licensee must meet the necessary requirements before the resident is admitted. Information gathered during interviews confirm the facility failed to do so in this situation.

Based on the evidence gathered through interviews, and document review, the preponderance of evidence standard has been met, therefore, the above allegations are SUBSTANTIATED. Violations are being cited per California Code of Regulations Title 22.

An exit interview was conducted, and a copy of this report and appeal rights were provided.

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) 703-2870
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20250327152606

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: 04/03/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/04/2025 Section Cited CCR 87468.1(a)(2)	1 2 3 4 5 6 7	(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not being met as evidenced by:	1 2 3 4 5 6 7	Executive Director will schedule an in-service training for all staff. The topic of the in-service training will cover Resident Rights. The executive director will email LPA Haley the sign in sheet for the in-service, the topics covered and the duration of the training. Executive Director will inform LPA of the dates of the training and provide an outline of what will be covered by the close of business on the POC due date.
	8 9 10 11 12 13 14	During interviews it was discovered a staff member was in a residents room for an extended period of time unauthorized. This is a health, safety and personal rights risk to residents in care.	8 9 10 11 12 13 14
Type A 04/04/2025 Section Cited CCR 87621(a)(2)	1 2 3 4 5 6 7	87621 Colostomy/Ileostomy (a) Except as specified in Section 87611(a), the licensee shall be permitted to accept or retain a resident who has a colostomy or ileostomy under the following circumstances: (2) If assistance in the care of the ostomy is provided by an appropriately skilled professional.	1 2 3 4 5 6 7	Executive Director Chon will read and review regulation sections 87468.1 and 87621. Executive Director Chon will email a statement of acknowledgement and understanding after reading the regulation sections. Executive Director will also email LPA Haley the plan of action to have an approiately skilled ptofessional maintain the coloctomy bag.
	8 9 10 11 12 13 14	This requirement is not being met as evidenced by: Interview confirmation and document review show caregivers who are not trained by a skilled professional are providing routine maintenance to a residents colostomy bag.	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.

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) 703-2870
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025

LIC9099 (FAS) - (06/04)

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