306005901-7-11-2025-22-AS-MSEY-DJLTX3-20250715150629

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005901
Report Date: 07/11/2025
Date Signed: 07/11/2025 11:58:32 AM

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
05/24/2023 and conducted by Evaluator Kerry Hiratsuka

COMPLAINT CONTROL NUMBER: 22-AS-20230524143909

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: 51	DATE:	07/11/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Christine Chon		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

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1. Facility staff did not adequately supervise resident while in care.
2. Facility staff failed to return resident's personal belongings.
3. Facility failed to issue a refund to responsible party.

INVESTIGATION FINDINGS:

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The department conducted the investigation into the allegations above. The department reviewed facility records, and conducted interviews. This complaint came in May 2023.

1. Title 22 Regulations does not require staff to have residents in line of sight or within earshot 24 hours a day, seven days a week. Title 22 Regulations require facilities to assess residents and determine how much supervision and care a resident requires. The resident in question was in the facility for a very short time prior to a fall. It appears the resident fell in between regular checks conducted by caregivers, which was approximately every two hours. Records did not indicate the resident required more frequent checks. It cannot be determined if the resident was not adequately supervised based on the different version of events.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kerry Hiratsuka	TELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025

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-20230524143909

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 MEMORY CARE	FACILITY NUMBER: 306005901
	VISIT DATE: 07/11/2025

NARRATIVE

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2. A review of the resident's file showed the client refused to have their personal belongings inventoried, but it was not signed or initialed by the resident or their responsible party. The belongings in question were a pair of shoes and wheelchair. Facility staff at the time stated the belongings were picked up and the witness stated the items were never returned. Because the inventory list was not signed or initialed it cannot be determined if the facility was responsible for keeping track of the resident's personal belongings.

3. A review of the admission agreement stated there was a pre-admission fee charged that was to be used for the rent as well and there is a refund schedule that is required by CA Health and Safety Code. The admission agreement also requires a 30 day notice of termination by the resident and/or responsible party. The resident in question was in the facility only for one week before sustaining a fall and not returning. A review of the resident's file indicates there was a refund issued but it cannot be determined if it is the correct amount because there is noting in the file indicating the pre-admission fee was paid by the resident's responsible party.

Therefore, LPA finds the allegation to be "unsubstantiated." A finding of unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the violation occurred.

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kerry Hiratsuka	TELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025

LIC9099 (FAS) - (06/04)

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