306005901-12-24-2024-22-AS-MSTC-DGP65Q-20250514203036

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005901
Report Date: 12/24/2024
Date Signed: 12/24/2024 02:11:13 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
12/17/2024 and conducted by Evaluator Jerome Haley

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20241217175306

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: 45	DATE:	12/24/2024
		UNANNOUNCED	TIME BEGAN:	12:01 PM
MET WITH:	Dennis Robeniol		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

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Feces was left in the common area of the facility.
Residents were not served or offered water with their meal/snack.

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.

Regarding the complaint allegation: Feces was left in the common area of the facility.
During the investigation, 7 of 8 individuals interviewed denied the complaint allegation. However, six staff members who were interviewed all confirmed a few residents in the Memory Care have been known to urinate in a corner or have a bowel movement in one of the common areas. The same staff members all went on to explain that housekeeping comes and cleans the areas and disinfects the areas right away. Staff 3 (S3) said the caregivers come in and clean it right away. Staff 5 (S5) confirmed a resident had a bowel movement by the elevator on the third floor. According to staff member, a housekeeper came and cleaned it right away. Staff 1 (S1) and Staff 2 (S2) both denied feces being left in any common area of the facility and both explained housekeeping will clean and disinfect right away.
Continued on LIC9099C

Unsubstantiated

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: 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)

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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

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When asked about specific spots on the floor, S2 explained a lot of chocolates are provided in the community during the activities and that what some of the stains are from. S2 said you can tell what it is when you wipe it. S2 also contributed some of the stains on the carpet to wheelchair wheels, and stains from trash bags being dragged across the floor.

Regarding the complaint allegation: Residents were not served or offered water with their meal/snack.

During the investigation, 5 of 8 individuals interviewed denied the complaint allegation.

According to multiple staff members interviewed, resident are always given liquids with their meals and snacks. Staff 1 (S1) said when meals are prepared sometimes you see multiple glasses prepared for the resident’s on the table. According to Staff 2 (S2), staff members will assist residents who can not use the hydration stations on their own and make sure the resident stays hydrated. S2 claims residents will come ask them for something to drink and the staff will assist the resident get something to drink from the hydration station.

Based on the information gathered during the investigation through interviews, document review, and observations, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, the allegations above are deemed Unsubstantiated.

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) 703-2870
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
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)

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