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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005901
Report Date: 04/03/2026
Date Signed: 04/03/2026 11:35:46 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
05/22/2024 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 22-AS-20240522095807
FACILITY NAME:BEACH TERRACE MEMORY CAREFACILITY NUMBER:
306005901
ADMINISTRATOR:ERIC JENSENFACILITY TYPE:
740
ADDRESS:12282 BEACH BOULEVARDTELEPHONE:
(503) 675-3925
CITY:STANTONSTATE: CAZIP CODE:
90680
CAPACITY:120CENSUS: DATE:
04/03/2026
UNANNOUNCEDTIME BEGAN:
11:33 AM
MET WITH:John Yoon, Operations DirectorTIME COMPLETED:
11:34 AM
ALLEGATION(S):
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9
Facility failed to follow residents prescribed diet.
Facility failed to follow medical orders resulting in residents tooth falling out.
Staff failed to report residents medical condition.
Staff speak limited English and can't communicate with residents.
Resident was not sent to the hospital after having an unwitnessed fall and complaining of pain.
INVESTIGATION FINDINGS:
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On 04/03/2026, Licensing Program Analyst (LPA) HIratsuka, contacted the facility via phone and email to deliver final findings regarding a complaint that was received on 05/22/2024. The time frame of the allegations is prior to the complaint received by the department

Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegations listed above. Therefore, the allegations above are
unsubstantiated.
A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Operatoins Director was advised the report is going to be emailed to him.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026
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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