306005901-7-14-2025-22-AS-MSEY-DJLW3T-20250715165627

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005901
Report Date: 07/14/2025
Date Signed: 07/14/2025 02:16:40 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
06/21/2024 and conducted by Evaluator Kerry Hiratsuka

COMPLAINT CONTROL NUMBER: 22-AS-20240621141843

FACILITY NAME:	BEACH TERRACE ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	306005901
ADMINISTRATOR:	ERIC JENSEN		FACILITY TYPE:	740
ADDRESS:	12282 BEACH BOULEVARD		TELEPHONE:	(530) 242-8300
CITY:	STANTON	STATE: CA	ZIP CODE:	90680
CAPACITY:	120	CENSUS: 51	DATE:	07/14/2025
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Christine Chon		TIME COMPLETED:	02:25 PM

ALLEGATION(S):

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1.Resident eloped from the facility due to lack of care and supervision
2. Licensee did not update the resident's reappraisal as needed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) conducted this unannounced complaint visit to deliver the results of the allegations above. The above allegations came in on 06/21/2024. The Department conducted an investigation the allegations above.

1. This facility has three floors; the first floor is the lobby and the second and third floor are for residents. The two floors for residents have emergency exits with delayed egress doors that have alarms and the elevators require a key card to use them. There were two incidents where the resident in question was able to leave the floor they were on without leaving the facility. Per the information the department was able to review, the resident did leave the facility once and was found off premises and care staff were assigned to supervise the resident.

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: 07/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2025

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-20240621141843

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: 07/14/2025

NARRATIVE

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This incident occurred shortly after the resident moved in. There were notes that the staff were instructed to be aware of the resident’s whereabouts and a possible one-one-one, but did not specify how long that was going to last. It cannot be determined if R1 was an elopement risk prior to moving into the facility because it cannot be determined if the resident had exit seeking behaviors prior to the first incident and the second two incidents the resident didn’t leave the facility grounds.

2. Title 22 regulations at the time required appraisals and needs/services plans to be updated when there was a change in condition or every twelve months, whichever came first. However, the regulations do not specify how much detail is required for each appraisal and needs/service plan to be. A review or R1’s file showed the resident’s needs and services plan was updated at least once after the resident moved in. Supervision was addressed, but because the regulations don’t specify how detailed the plan is supposed to be, it cannot be determined whether the appraisal met the resident’s needs or not.

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: 07/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2025

LIC9099 (FAS) - (06/04)

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