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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006386
Report Date: 06/17/2024
Date Signed: 06/17/2024 05:00:18 PM


Document Has Been Signed on 06/17/2024 05:00 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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



FACILITY NAME:SEASIDE TERRACEFACILITY NUMBER:
306006386
ADMINISTRATOR:PEDROZA, TRICIAFACILITY TYPE:
740
ADDRESS:9925 LA ALAMEDA AVETELEPHONE:
(714) 962-5531
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:250CENSUS: 126DATE:
06/17/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:31 PM
MET WITH:Ephantus Warui, AdministratorTIME COMPLETED:
05:05 PM
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 On today's date, LPA Quiroz was greeted by Front desk concierge and met with Administrator (AD) Ephantus Warui and explained the purpose of the inspection visit.
This unannounced Case Management – Other inspection visit is being conducted by Licensing Program Analyst (LPA) Rosie Quiroz for the purpose of delivering findings for Closed facility Seaside Terrace Retirement Community #306004415 Complaint Control Number: 22-AS-20231004143105
During today's inspection, LPA Quiroz along with AD Ephantus Warui toured the interior and exterior of the facility premises. During today's visit, LPA Quiroz observed new floor, new paint, new chandelier in facility entrance. On February 9, 2024 Orange County Regional Office received email and telephone notification of facility renovation.
During today's visit, AD Warui verified all residents and their responsible parties were notified of facility renovation. AD Warui indicated facility roof renovation was completed on June 1, 2024 and indicated foreseeing renovation completion of floor on second story to be completed by July 1, 2024. AD Warui agreed to provide Community Care Licensing Division with updates.

An exit interview was conducted with AD Warui, and copy of this report was provided at exit. .
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:
DATE: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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