306005901-7-3-2023-22-AS-SSAS-CTGR5B-20230706124250

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005901
Report Date: 07/03/2023
Date Signed: 07/03/2023 01:36:30 PM

Unfounded

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
04/04/2023 and conducted by Evaluator Jerome Haley

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230404091722

FACILITY NAME:	BEACH TERRACE MEMORY CARE		FACILITY NUMBER:	306005901
ADMINISTRATOR:	EDWARDS, CYNTHIA		FACILITY TYPE:	740
ADDRESS:	12282 BEACH BOULEVARD		TELEPHONE:	(503) 675-3925
CITY:	STANTON	STATE: CA	ZIP CODE:	90680
CAPACITY:	120	CENSUS: 43	DATE:	07/03/2023
		UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Eric Jensen - Executive Director		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Unqualified staff providing care and supervision to residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jerome Haley made unannounced visit regarding the complaint allegation above. LPA Haley was granted entry and explained the reason for the visit with upon entry. During the visit LPA Haley briefly interviewed Executive Director (ED) Eric Jensen and Staff 5 (S5) to gather additional information.

Regarding the allegation, the investigation revealed the following:
During interviews, 7 of 7 witnesses failed to provide any evidence or information to support the complaint allegation. Further, a review of documents provided (job description, training records), contradict the complaint allegation mentioned above.

Based on the information gathered during the investigation through interviews, and record review, the allegation mentioned above is deemed Unfounded, meaning the allegation is false, could not have happened and/or is without a reasonable basis.
An exit interview was conducted, and a copy of this report was provided.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023

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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