306005901-10-25-2023-22-AS-SSAS-CXEUHW-20231109143633

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005901
Report Date: 10/25/2023
Date Signed: 10/25/2023 03:57:00 PM

Substantiated

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
09/07/2023 and conducted by Evaluator Jerome Haley

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230907130523

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: 46	DATE:	10/25/2023
		UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Eric Jensen - Executive Director		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility plumbing is not providing hot water

INVESTIGATION FINDINGS:

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LPA Haley made an unannounced visit to the facility to deliver the findings on the complaint allegation above. LPA Haley was greeted by staff and explained the reason for the visit.

Regarding the allegation: Facility plumbing is not providing hot water

8 of 8 witnesses confirmed the complaint allegation to be true. The investigation into the complaint allegation above revealed, on August 22, 2023 information was shared with the Executive Director (ED) Eric Jensen that there was water leaking from the hydro pump that provides hot water to the building. The next day on August 23, 2023 more water was observed leaking from the pump but there was still hot water in the building. On August 24, 2023 it was discovered the hydro pump was no longer working and there was no hot water in the building. While the facility worked on a solution to make necessary repairs, the residents went without hot water from August 24, 2023 until September 9, 2023.

Substantiated

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: 10/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023

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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Control Number 22-AS-20230907130523

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: BEACH TERRACE MEMORY CARE	FACILITY NUMBER: 306005901
	VISIT DATE: 10/25/2023

NARRATIVE

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The facility received a temporary boiler to supply the facility with hot water on September 8, 2023 and the temporary boiler was installed the next day (9.9.23), and the facility had hot water for the first time since August 24, 2023.

During the initial visit to the facility on September 14, 2023 the hot water temperatures were recorded in 5 random rooms while touring the facility with staff. The following temperatures were recorded:

Room #215 – 105.6 degrees Fahrenheit, Room #223 – 104.3 degrees Fahrenheit, Room #304 – 113.9 degrees Fahrenheit, Room #328 – 100.5 degrees Fahrenheit, Room #329 – 103.2 degrees Fahrenheit

3 of 5 rooms’ hot water temperature was below regulation requirements.

During a visit to the facility on October 18, 2023, regarding complaint control number 22-AS-20231016115710, while touring the facility with staff, hot water temperatures were recorded for 4 additional rooms:

Room #206 – 96.0 degrees Fahrenheit, Room #230 – 103.1 degrees Fahrenheit, Room #306 – 95.3 degrees Fahrenheit, Room #315 – 98.2 degrees Fahrenheit

4 of 4 rooms’ hot water temperature was below regulation requirements.

While the hot water was out it was discovered the residents received bed baths and if a resident had an accident and really needed a shower, they would receive a cold shower. During interviews it was discovered, the decision to get a temporary boiler to supply the facility with hot water was made because it was going to take a long time to get the parts necessary to make the repairs, and the decision was made after the facility was without hot water for several days. The decision to get the temporary boiler was made sometime between September 1, 2023 and September 4, 2023.

Based on the evidence gathered during interviews, and document review the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. Violations are being cited per California Code of Regulations Title 22, Division 6.

An exit interview was conducted and a copy of this report and appeal rights were provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 22-AS-20230907130523

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: BEACH TERRACE MEMORY CARE	FACILITY NUMBER: 306005901
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/25/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/27/2023 Section Cited CCR 87303(e)(2)	1 2 3 4 5 6 7	87303 (e)(2) Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) faucets used by residents for personal care...shall deliver hot water. Hot water temperature controls shall be maintained to... a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C).	1 2 3 4 5 6 7	Executive Director will provided a detailed outline on the steps that will be taken to prevent residents from being without hot water for an extended period of time if there is another plumbing issue. The facility boilers have been fixed and are supplying hot water to the facility as of October 16, 2023. The detailed outline will be emailed to LPA Haley by the POC due date: Friday, October 27, 2023 at 1PM.
	8 9 10 11 12 13 14	This requirement was not being met as evidenced by the facility beign out of hot water from August 24, 2023 until September 9, 2023 when the back up boilers were installed to provide hot water to the building. This poses a health and safety risk to residents in care.	8 9 10 11 12 13 14
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023

LIC9099 (FAS) - (06/04)

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