Beach Homes III

Type of visit: Required - 1 Year

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for six non-ambulatory residents. Facility has an approved hospice waiver for six residents and the home currently has six residents, with three residents on hospice. Administrator (AD) Andy Beach arrived shortly to assist with the visit. LPA along with staff toured the facility at 8:46 AM. LPA toured the physical plant, checked food service, and facility documentation. The home consists of six resident bedrooms, staff room, living room, dining room, and kitchen, seven bathrooms and an attached garage. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 112.8 degrees F and 117.5 degrees F in all bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Four out of six auditory exit alarms were operational during today's visit. LPA toured the kitchen and observed sharps locked in a cabinet during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility conducted last emergency drill on 01/28/2026. Outside grounds were toured. Walkways around the home were clear of hazards. There is shaded outdoor seating for residents. Exit gate is unlocked and operational. LPA observed the emergency water supply. First aid kit contained all required items including tweezers, scissors and thermometer. LPA reviewed six resident files and three staff files. All resident files contained required documentation including admission agreements, physician reports, and resident appraisals. Staff files reviewed contained required documentation including required annual training, medical assessment/ TB, and criminal record clearance. LPA reviewed medication storage and administration. Medications are stored in a locked cabinet. Medications are being administered per physician order. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided.the state’s words, verbatim · CDSS document, Feb 19, 2026

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Facility failed to arrange appropriate medical care after resident fell and hit their head.

Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to finalize an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. It was alleged facility failed to arrange appropriate medical care after resident fell and hit their head. During the investigation, LPA conducted interviews with staff. LPA reviewed records obtained. The investigation determined as follows: Regarding the allegation facility failed to arrange appropriate medical care after resident fell and hit their head, it was reported resident 1 (R1) had an unwitnessed fall on January 14, 2025 causing head trauma. LPA interview with two out of four staff stated R1 slid down the recliner in the living room while receiving physical therapy by a therapist. The two staff added they assisted picking up R1 and placed them back onto the recliner and conducted a body check. R1 was observed to have a skin tear above the left eye. Continued on LIC9099-C dated 01/22/2026. Substantiated The two staff stated R1 was observed to be at baseline before and after the fall. Two out of three staff stated R1's family member arrived shortly after and was explained the incident. The remaining staff did not add anything relevant to the incident occurring on January 14, 2025. Two out of three staff stated R1's family member came later to visit R1 on January 15, 2025. Two out of three staff added R1's family member believed R1 was not at their baseline and called 911 to transport R1 to the hospital. The remaining staff did not add anything relevant to the incident occurring on January 15, 2025. Interview with Administrator AD Andy Beach stated the incident was not reported to R1's Primary Care Physician (PCP). Record review revealed R1 was diagnosed with a urinary tract infection and prescribed an antibiotic. R1 returned to the facility the same day. Based on interviews conducted and record review, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6), are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of the report was left with the facility representative along with appeal rights.the state’s words, verbatim · CDSS document, Jan 22, 2026 · control 22-AS-20260116113625

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87466 · Plan of correction due date: Jan 29, 2026

The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning... When changes ... are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician... The requirement was not met as evidenced by: R1's PCP was not notified of R1's fall which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jan 22, 2026

Plan of correction: AD stated PCPs for all residents will be notified during incidents. AD stated statement of understanding will be sent to LPA by POC due date.

Allegation investigated: Facility failed to arrange appropriate medical care after resident fell and hit their head.

Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to finalize an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. It was alleged facility failed to arrange appropriate medical care after resident fell and hit their head. During the investigation, LPA conducted interviews with staff. LPA reviewed records obtained. The investigation determined as follows: Regarding the allegation facility failed to arrange appropriate medical care after resident fell and hit their head, it was reported resident 1 (R1) had an unwitnessed fall on January 14, 2025 causing head trauma. LPA interview with two out of four staff stated R1 slid down the recliner in the living room while receiving physical therapy by a therapist. The two staff added they assisted picking up R1 and placed them back onto the recliner and conducted a body check. R1 was observed to have a skin tear above the left eye. Continued on LIC9099-C dated 01/22/2026. Substantiated The two staff stated R1 was observed to be at baseline before and after the fall. Two out of three staff stated R1's family member arrived shortly after and was explained the incident. The remaining staff did not add anything relevant to the incident occurring on January 14, 2025. Two out of three staff stated R1's family member came later to visit R1 on January 15, 2025. Two out of three staff added R1's family member believed R1 was not at their baseline and called 911 to transport R1 to the hospital. The remaining staff did not add anything relevant to the incident occurring on January 15, 2025. Interview with Administrator AD Andy Beach stated the incident was not reported to R1's Primary Care Physician (PCP). Record review revealed R1 was diagnosed with a urinary tract infection and prescribed an antibiotic. R1 returned to the facility the same day. Based on interviews conducted and record review, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6), are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of the report was left with the facility representative along with appeal rights.the state’s words, verbatim · CDSS document, Jan 22, 2026 · control 22-AS-20260116113625

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87466 · Plan of correction due date: Jan 29, 2026

The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning... When changes ... are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician... The requirement was not met as evidenced by: R1's PCP was not notified of R1's fall which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jan 22, 2026

Plan of correction: AD stated PCPs for all residents will be notified during incidents. AD stated statement of understanding will be sent to LPA by POC due date.

Type of visit: POC

Licensing Program Manager (LPA) Fred Arias made an unannounced visit to conduct a plan of correction visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. LPA verified corrections for 2 deficiencies have been made from cited sections CCR 87309(a) and HSC 1569.695(c). Administrators Julius and Sandy Sevilla arrived shortly during the visit. LPA printed Plan of Correction clearance letters for deficiencies cleared. This report was discussed with the facility representative and a copy was provided.the state’s words, verbatim · CDSS document, Mar 3, 2025

Type of visit: Required - 1 Year

On February 25th, 2025 Licensing Program Analyst (LPA) William Vanegas made an unannounced inspection for the purposes of an annual inspection. Upon arrival LPA Vanegas was greeted and granted entry to the facility by Administrator (AD) Julius Sevilla. Upon arrival it was advised that annual visit was completed and LPA Vanegas did not complete an annual visit. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Feb 25, 2025

Type of visit: Required - 1 Year

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA were greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 4 residents and the home currently has 6 residents, with 3 residents on hospice. Administrators (ADs) Julius Sevilla and Sandy Sevilla arrived shortly to conduct facility tour. Licensee Andy Beach arrived later during the visit. LPA along with AD toured the facility at 9:45 AM. LPA toured the physical plant, checked food service, facility documentation and the first aid kit. The home consists of 6 resident bedrooms, living room, dining room, staff room and kitchen as well as 7 bathrooms. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 112.2 degrees F and 118 degrees F in all bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarms were operational during today's visit. LPA toured the kitchen at 9:50am and observed sharps unlocked in a slightly ajar drawer in the kitchen unsupervised during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. At 10:20am, LPA observed laundry detergent in an unlocked cabinet by the washer and driver and on the floor. LPA observed opened bottles of drinking alcohol and milk of magnesia in an unlocked refrigerator in the garage. The door access to the garage in unlocked. Prescription toothpaste was observed in resident 2's bathroom. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. The last disaster drill was conducted on 5/21/2024. Outside grounds were toured. One out of two exit gate walkways has gravel on the path throughout. Exit gates are unlocked and operational. CONTINUED ON LIC 809C DATED 2/20/2025. There are no security bars or weapons on the premises. First aid kit contained all required items except tweezers. Facility conducts activities in the form of exercise. There is shaded outdoor seating for residents. LPA observed the emergency food and water supply. LPA reviewed six resident files and two staff files. All resident files contained required documentation including admission agreements, physician reports, and resident appraisals. Staff files reviewed contained required documentation including required annual training, medical assessment/ TB, criminal record clearance and proof of CPR training. LPA reviewed medication storage and administration. Medications are stored in a locked cabinet. Medications are being administered per physician order. Some medications were observed stored in a daily pill box. Based on the observations made during today’s visit, the following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided along with appeal rights.the state’s words, verbatim · CDSS document, Feb 20, 2025

The state marks this report as 9 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Allegation investigated: Facility staff failed to supervise a resident resulting in an elopement from the facility

This unannounced investigation inspection by Licensing Program Analyst (LPA) Dwayne Mason Jr. is being conducted to conclude this agency’s investigation in the complaint allegation(s) mentioned above. LPA arrived at the facility and was greeted by Caregiver Elizabeth Serpas. LPA met with Samantha Chiascione, Administrator (AD) and explained the nature of the inspection. The department received a complaint on 5/9/2024 stating facility staff failed to supervise a resident resulting in an elopement from the facility and that the facility did not adequately report the elopement to the department. The Reporting Party (RP) disclosed that the elopement resulted in local law enforcement being called. During the investigation, the department interviewed Administrator (AD), staff and residents in care. (continued on LIC9099-C) Unsubstantiated (continued from LIC9099) On 5/15/2024 LPA conducted a visit to the facility. LPA interviewed Administrator (AD), staff and residents in care. Interviews conducted with AD and staff revealed that S1 observed R1 attempting to depart the facility through the front door. S1 followed R1 out the door attempting to de-escalate R1 as they began to walk away from the facility. AD arrived at facility and joined S1 in attempting to de-escalate R1. AD instructed S1 to return to the facility. AD contacted local law enforcement. AD was able to de-escalate R1 and returned to the facility with R1. According to interviews with AD, staff and Resident 2, Resident 1 was never unsupervised. AD and staff corroborated the allegation that the facility did not adequately report the elopement to the department. LPA interviewed Resident 1 who could not recall the details of the incident in question and made no disclosures regarding the allegations. LPA obtained copies of the following files for Resident 1: Admission Agreement, Pre-Placement Appraisal and Physician's Report. LPA obtained copies of the following staff files: personnel reports, protocol for walking with residents and training records. LPA obtained copies of the client roster, and record of staff working at facility on 3/27/24. On 5/15/2024 LPA returned to the facility and conducted interviews with AD and Resident in care. AD made no further disclosures regarding the allegation. Resident 3 could not recall the details of the event in question and made no disclosures regarding the allegations. Due to interviews conducted, LPA was unable to determine if facility staff failed to supervise a resident resulting in an elopement from the facility. Based on interviews conducted and records reviewed there is insufficient evidence to support the allegation. Although the allegation(s) may have happened or is valid; there is not a preponderance of evidence to prove that the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and this report was reviewed with Administrator. A copy of this LIC-9099 was provided to the facility.the state’s words, verbatim · CDSS document, May 31, 2024 · control 22-AS-20240509112030

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Dwayne Mason Jr. arrived at the facility unannounced for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into facility by Administrator Samantha Chiascione. The facility is a one-story home with six resident bedrooms, seven bathrooms, kitchen, dining room, living room, staff room, backyard and attached 2-car garage. LPA observed residents lounging in their rooms and in the backyard, receiving therapy or interacting with staff. All resident rooms had the required elements, including bed, chair, closet space and ample lighting. Facility has extra linens for residents in the living room cabinets. Restrooms are stocked with soap and paper towels and have hand washing postings. Hot water in bathrooms measured between 105 and 120 degrees Fahrenheit. Two bathrooms' hot water were measured close to 120 degrees Fahrenheit. LPA advised facility maintain a water log as the warmer months approach. LPA observed facility has emergency food and water supply. LPA noted Fire Extinguishers were last serviced on 5/8/2024. LPA observed hazardous items such as knives, chemicals and cleaners to be locked up in cabinets in the kitchen and garage. Knives are locked up separate from toxic chemicals. Medication for each client is kept locked in a cabinet in the living room. Exit gate is unlocked and self latching. LPA reviewed resident and staff files. LPA interviewed three staff and one resident. Based on record review, LPA observed the facility has not conducted quarterly disaster drills in the last year. A deficiency is being issued. Based on today's inspection, one deficiency is being issued. An exit interview was conducted and a copy of this report and appeal rights were provided to the facility.the state’s words, verbatim · CDSS document, May 15, 2024