Seaside Terrace

Allegation investigated: Staff interfered with residents’ reasonable access to leisure activities Staff did not speak to the resident in a respectful manner

Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to investigation the above identified complaint allegations and deliver findings. LPA arrived at facility and was greeted and granted entry by staff. LPA spoke with Ephantus Warui, Administrator and explained the purpose of the visit. During the course of the investigation, interviews were conducted, a tour of the physical plant of the facility was conducted, a review of records was completed and copy of pertinent documents obtained. It is alleged that staff interfered with residents’ reasonable access to leisure activities. Specifically, to access to the TV’s in the facility. LPA on today’s visit toured the physical plant of the facility and observed there is a TV room on the first floor and one in the second floor, and a TV in the activities room primarily Continued on LIC9099-C Unsubstantiated used for activities. LPA observed that remote controls for the TV’s are kept in the front desk of the main entrance of the facility. LPA observed that both first floor and second floor TV rooms had the TV on the news and on a movie. The activities room had activities going on throughout the day with residents participating. Interview with 4 of 4 staff stated that the remote for the TV’s have always been kept in the front desk with staff and that residents request for the channel to be changed or to turn on the TV in which staff do that for the resident. This has always been in place for safe keeping of the remote and for them not to get lost or misplaced, which has happened in the past. There are three TV's one on each TV room and one in the activities room which is primarily used for activities. When there is no activities in the room residents can use it to watch TV in there. Interview with 10 of 10 residents stated that the TV’s in the TV rooms if they need the channel to be changed or need the remote, they go to the front desk and ask the staff. That is the way they get the channel changed by staff or by the remote itself. The TV in the activities room is used for activities and when not doing activities residents can watch the TV. There is access to the TV's in the facility all the time. It is alleged that staff did not speak to the resident in respectful manner. Interview with 10 of 10 residents stated that staff speak to them in a respectful manner and have not seen any staff be rude or disrespectful towards any other person at the facility. Residents stated that the staff are good to them and they get what they need from them. Interview with staff stated that they treat residents with respect. There are times when they talk to a resident and when resident does not get the answer they want, the resident insists and follows staff around the facility asking the same question hoping for a different answer. Staff will do their best to address the residents’ concerns and be respectful of them. Staff have not gotten any complaints from residents about any staff being disrespectful. Based on the information mentioned above, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed Unsubstantiated. An exit interview was conducted with the Administrator, and a copy of this LIC9099 report was left at facility.the state’s words, verbatim · CDSS document, Aug 19, 2026 · control 22-AS-20260812143758

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Hanna Gough and Ruth Martinez made an unannounced visit to the facility to conduct the required annual inspection. LPAs were greeted and granted entry by staff. LPAs met with Administrator (AD) Ephantus Warui and discussed the purpose of the visit. The facility currently has 147 residents in care. The facility is a two story building with resident apartments, bathrooms, activity room, dining room, medication room, memory care unit and staff offices. LPAs observed the memory care unit to be on the first floor with delayed egress doors that were found to be operational. LPAs observed the memory care unit to have resident apartments and an activity room/dining room with access to an outdoor shaded seating area. LPAs observed all resident bedrooms had the required components and furnishings. LPAs observed a hole in the wall of room 120 where exposed wires were observed. LPAs observed the bathrooms to have toilet paper, paper towels and non slip mats in the shower. LPAs tested the water to be between 106.7 to 119.1 degrees Fahrenheit. LPAs observed the laundry rooms to be locked and made inaccessible to residents in care. LPAs observed the extra linens to be on the second floor. LPAs observed toxins and chemicals to be in a locked room on the first floor. LPAs observed the emergency food and water supply to be in a closet on the first floor. LPAs observed the medication room on the first floor to be locked and made inaccessible to residents in care. LPAs observed the facility to have a completed first aid kit in the medication room. LPAs observed the kitchen to be clean and free of vermin. LPAs observed all appliances to be operational. LPAs observed the knives to be in the kitchen and made inaccessible to residents in care. LPAs observed the activities being conducted in the activity room during the duration of the inspection. LPAs observed the pull chord system to be operational with an immediate verbal response from the front desk and a 2 minute physical response time from care staff. LPAs observed an outdoor shaded seating area in the middle of the facility for resident enjoyment. Continue on LIC 809C LPAs observed all walkways to be free of debris and obstructions. The carbon monoxide detector found on the second floor was found to be operational. LPAs observed fire extinguishers charged and with a service date of August 5, 2025, throughout the facility. LPAs reviewed staff files and no discrepancies were observed and all staff files reviewed were found to have background clearances and associations to the facility. LPAs reviewed resident files and no discrepancies were observed. LPAs reviewed resident medications and no discrepancies were observed. LPAs reviewed a sprinkler inspection report from K Line Fire Equipment Co dated December 12, 2025, stating that the sprinkler system passed the inspection. LPAs reviewed a report from the City of Fountain Valley Fire Prevention Unit stating that on December 1, 2025, the facility smoke detectors passed inspection. LPAs reviewed an in service training was conducted on May 12, 2026, covering the disaster drill training. Based on today’s inspection, deficiencies were noted per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with LIC 809D, and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, May 21, 2026

Allegation investigated: Staff did not seek medical attention for resident. Staff did not safeguard resident’s personal belongings. Staff did not notify resident of changing room.

On February 19, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived at the facility for an unannounced subsequent complaint investigation into the above allegations. LPA was greeted and granted entry after stating the purpose of the visit to Administrator (AD) Ephantus Warui. The investigation into the above allegations revealed the following: During the course of the investigation, LPA conducted a tour of the physical plant and obtained pertinent documentation which includes Resident/Personnel Rosters, Personnel Reports, Staff Contacts, Resident 1 and Resident 2 (R2) Face Sheets, Physician’s Report, Progress Note, Community Policy Violation Warnings, Admission Agreement, House Rules, Theft and Loss Policy and Procedure, Resident Personal Property and Valuables (LIC621), and Hospital Discharge records. CONTINUE TO LIC9099-C.... Unsubstantiated Regarding the allegation, Staff did not seek medical attention for resident, it is alleged that staff did not seek medical attention in a timely manner for R2. Five out of five facility staff denied the allegation, stating R2 that emergency services were called promptly when R2 reported chest pain and difficulty breathing. The resident was transported to the hospital, and passed away there thre days later. During an interview conducted, R2’s family/Witness 2 (W2) denied the allegation, stating that they believe the facility contacted emergency services timely and do not suspect any delay in response. Based on Hospital Discharge records dated June 4 2025, R2 passed away on May 31, 2025 due to a preexisting condition. Regarding the allegation, Facility failed to safeguard resident’s personal items, it is alleged that staff did not safeguard Resident 1’s personal belongings by removing and/or disposing of residents’ cooking appliances, cookware, refrigerator, vegan food items, cash, and additional personal items without residents’ consent on September 12, 2025. LPA conducted interviews with Resident 1 (R1), Witness 1 (W1), four additional residents, and five staff. During the course of the investigation, R1 and W1 provided LPA with a list of personal belongings that were reported to have been removed from R1’s room by staff on September 12, 2025, without R1’s consent. Based on records reviewed, the facility provided all residents with notice on two separate occasions, that rooms would be inspected and hazardous items and items that may create a risk to residents’ health and safety, would be removed. Five out of five facility staff interviewed, denied the allegation, stating that R1 was present during the inspection of the room, the room required deep cleaning due to unsanitary conditions including: scattered and rotten food, and soiled carpet damage, which posed an immediate risk to R1 and roommate. When interviewed, R1 was not able to provide proof that cash on list provided, was in the R1’s room on September 12, 2025 and removed by staff. Personal property on R1’s list, including cash, was not inventoried upon admission, as per the Resident Personal Property and Valuables (LIC621). LPA conducted a follow-up interview with R1 and it was confirmed that the LIC621 was not completed or updated by the resident upon or after admission. R1 stated they started to bring in more items that were hard to track and notify the facility about the existence of such items.During a walk though of R1’s room, LPA observed R1’s room, the room was found unorganized and unsanitary with unwrapped food on the table and gnats flying around the uncovered food. Based on LPA’s observations, the uncovered food had been sitting on the table for several hours or longer. The refrigerator was observed in unsanitary condition with 3-4 spills in different areas inside, that had not been wiped/cleaned, and there were multiple food items inside the refrigerator with mold growing on them. LPA also observed perishable and non-perishable food items in R1s room that were past the expiration date. Photos were taken. Additionally, four out of five residents interviewed denied the allegation and confirmed that the facility provided all residents with notice on two separate occasions, indicating hazardous items and items that may create a risk to residents’ health and safety would be removed from their rooms. Regarding the allegation, Staff did not notify resident of changing rooms, it is alleged that staff did not give R1 advanced notice of room change from #286 to #287 on September 12, 2025. Record review of R1’s Admission Agreement signed on December 30, 2024, 12. Room Change Notification states the resident will be notified 30 days in advance of room change “unless …necessary due to any emergency.” Five out of five staff interviewed stated R1’s room was in such unsanitary conditions, including the soiled carpet, that there was an emergent need to relocate R1 and roommate to the neighboring room (Room #287) without advanced notice. Room# 287 had been previously remolded, with newly finished hard wood floors. During interview, R1 stated they would prefer to remain in Room #287, even after renovations are completed on Room #286, where they previously resided. Therefore, based on the observations made, interviews which were conducted, and the records that were reviewed, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the following allegations, Staff did not seek medical attention for resident, Staff did not safeguard resident’s personal belongings, and Staff did not notify resident of changing room, are deemed UNSUBSTANTIATED. An exit interview was conducted with Administrator Ephantus Warui, and a copy of this report was provided at exit.the state’s words, verbatim · CDSS document, Feb 19, 2026 · control 22-AS-20250915114013

Allegation investigated: Facility is violating resident's personal rights.

On February 19, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived at the facility for an unannounced subsequent complaint investigation into the above allegation. LPA was greeted and granted entry after stating the purpose of the visit to Administrator (AD) Ephantus Warui. The investigation into the above allegation revealed the following: During the course of the investigation, LPA conducted a tour of the physical plant and obtained pertinent documentation which includes Resident/Personnel Rosters, Personnel Reports, Staff Contacts, Resident 1 Face Sheets, Physician’s Report, Progress Note, Community Policy Violation Warnings, Residency Agreement, Theft and Loss Policy and Procedure, Resident Personal Property and Valuables (LIC621) and House Rules. CONTINUE TO LIC9099-C.... Unsubstantiated Regarding the allegation, Facility is violating resident's personal rights, it is alleged that staff violated Resident 1’s (R1's) personal rights by removing cooking appliances from R1's room and taking possession of R1's cooking appliance upon delivery to the facility, without resident’s permission. During the course of the investigation, LPA conducted interviews with five residents and five staff. Five out of five staff denied the allegation stating R1 was given verbal and written notice that cooking and cooking appliances were not permitted in R1's room, as they were considered a hazard and Healthy & Safety risk. Based on records reviewed, the facility provided all residents with notice on two separate occasions, that hazardous items and items that may create a risk to residents’ health and safety, would be removed from resident rooms, following inspection. Record review revealed, fire alarms in R1s room were activated on August 28, 2025 and September 28, 2025. The resident was initially provided with a verbal warning and then written notice following the second incident. When interviewed, R1 stated they received notices regarding upcoming room inspections by the facility and items considered hazardous to residents' health and safety, however, R1 stated they intentionally hid cooking appliances from staff as they knew these items were not permitted. Upon inspection, cooking appliances and cookware were removed from R1's room. House Rules signed by R1 dated March 1, 2024, state "22. Residents are prohibited from cooking or having any cooking equipment in their room besides the microwave that is provided by the facility." During interview, R1 stated they reordered a cooking appliance that was delivered to the facility on October 8, 2025, and S1 intercepted the delivery. Staff denied the allegation, stating they delivered the item to R1's room and R1 then came downstairs with S1, to the facility office to store the item, as they agreed it was prohibited. S1 stated the item will be returned to resident upon move-out. Photos were taken of the item in facility storage. Therefore, based on the observations made, interviews which were conducted, and the records that were reviewed, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the following allegation, Facility is violating resident's personal rights., is deemed UNSUBSTANTIATED. An exit interview was conducted with Administrator Ephantus Warui, and a copy of this report was provided at exit.the state’s words, verbatim · CDSS document, Feb 19, 2026 · control 22-AS-20260123165706

Type of visit: Case Management - Other

On January 29, 2026, Licensing Program Analyst (LPA) Eboni Bentley made an unannounced case management visit for the purpose of following up on an three eviction notices and one unlawful detainer submitted to the Orange County Regional Office. LPA met with Licensee (LI) Tricia Pedroza and Administrator (AD) Ephantus Warui and explained the purpose of the visit. Based on the information obtained during today’s visit, the facility appears to have taken the appropriate action according to the mandated reporting requirements, and the facilities policies and procedures. No citations issued on today’s date. An exit interview was conducted with Licensee Tricia Pedroza and Administrator Ephantus Warui, and a copy of this report was provided at the end of the visit.the state’s words, verbatim · CDSS document, Jan 29, 2026

Allegation investigated: Facility is not sanitary.

On October 30, 2025, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of initiating the complaint investigation into the above allegation. LPA was greeted and granted entry by Administrator Ephantus Warui and explained the purpose for the visit. During today’s visit, LPA interviewed facility staff, residents, and copies of records were obtained for review: Resident Roster, Personnel Report Summary, Face Sheets, Admission Agreements, Physician's Reports, and Needs and Services Plans for five residents. Regarding the allegation: Facility is not sanitary, it was alleged that residents are living in unsanitary conditions, where a photo was provided to the Department of a toilet with urine inside and a ½ inch sized feces satin on the seat. CONTINUE TO LICE9099-C.... Unsubstantiated LPA conducted a tour of the facility, and observed all common areas are clean, sanitary, and free of hazards. During tour, LPA observed two housekeepers cleaning common areas and rooms on the second floor. LPA observed five resident rooms and bathrooms were clean and sanitary. LPA inspected the bathrooms, including the toilets, which were observed to be clean. LPA conducted five resident interviews of which all five interviews did not corroborate with the allegation by stating that staff are cleaning rooms daily and upon request. LPA conducted a total of 3 staff interviews of which all 3 interviews did not corroborate with the allegation by stating that facility is sanitary and cleaned on a daily basis. Based on the observations made and interviews conducted, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed UNSUBSTANTIATED. An exit interview was conducted with Administrator Ephantus Warui, and a copy of this report was provided at the end of the visit.the state’s words, verbatim · CDSS document, Oct 30, 2025 · control 22-AS-20251023114754

Allegation investigated: Illegal eviction

On October 7, 2025, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of initiating the complaint investigation into the above allegation. LPA was greeted and granted entry by Licensee (LI) Tricia Pedroza and explained the purpose for the visit. Administrator (AD) Ephantus Warui arrived a short time later and was present for the visit. During the investigation, LPA interviewed facility staff, residents, and reviewed relevant documentation including two eviction notices’ served to the resident. Regarding the allegation: Illegal Eviction During interviews, two residents and two facility staff confirmed eviction notices were issued to Resident 1 (R1). Furthermore, during interviews both facility staff confirmed both eviction notices served to R1 were CONTINUE TO LIC-9099-C... Substantiated incomplete and agreed to correct the errors on the previously issued eviction notices. During an interview with R1, the resident confirmed they did indeed breach the Resident Agreement and House Rules that were agreed to upon admission. Record review revealed R1 was served two different eviction notices that failed to meet regulation guidelines. The first notice dated September 4, 2025, was inaccurate, and the second eviction notice dated September 11, 2025 was incomplete. The first eviction notice served (September 4, 2025) was inaccurate, as the eviction notice did not have the correct addresses for the California Department of Social Services or the correct address for the Long Term Care Ombudsman as required by regulation guidelines. The second eviction notice served (September 11, 2025) was incomplete. The second eviction notice did not have the required information for alternative resources/options to assist with housing and care options as required by regulation guidelines. Based on the evidence gathered through interviews and document review, the preponderance of evidence standard has been met, therefore the following allegation: Licensee did not follow proper eviction procedures is deemed SUBSTANTIATED. A violation is being cited per California Code of Regulations (CCR) Title 22, Division 6, Chapter 8. An exit interview was conducted with Licensee Tricia Pedroza and Administrator Ephantus Warui, LIC9099-D, LIC811, and a copy of this report and appeal rights were provided at exit.the state’s words, verbatim · CDSS document, Oct 7, 2025 · control 22-AS-20250929134237

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87224(a) · Plan of correction due date: Oct 8, 2025

Eviction Procedures - The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty days written notice to the resident is required... This requirement was not met as evidenced by: Based on interviews and document review, the facility issued an eviction notice without following regulation guidelines. The department did not receive complete and accurate eviction notices for review. This poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 7, 2025

Plan of correction: Facility representative states, the eviction notice will be rescinded and notification will be emailed to R1's family, LPA Bentley. The plan of correction is due by 5:00pm on the POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1 Year Annual evaluation. LPA was greeted and granted entry by Licensee Tricia Pedroza followed by Administrator (Admin) Ephantus Warui after explaining the reason for the visit. The certificate for Admin Warui is currently valid expiring on June 9, 2027. The following was observed during the tour: This is a two story building comprised of an Assisted Living (AL) and Memory Care (MC) unit on the first floor with AL on the second floor. Facility operates within the conditions and limitations specified on the license as there were 151 residents in care of which 7 were under hospice. LPA toured the physical plant accompanied by the Admin. Facility is clean, sanitary, odorless, and in good repair. LPA inspected all common areas which includes but is not limited to: the storages, activity rooms, television rooms, community shower/bathrooms, kitchen, dining, and medication room. LPA inspected 3 MC and 2 AL resident units on the 1st floor with 5 more AL units on the second floor which is a total of 10 units. The residents' units were appropriately furnished, beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage space for each residents' personal belongings were observed. All bathrooms were found to be in compliance, clean, and operational. However, the hot water temperature exceeded 2-3 degrees in four out of the ten apartment units measuring at 123.8, 123.6,122.3, and 120.2 degrees Fahrenheit which was readjusted during the visit. Admin agreed to adjust accordingly to ensure temperature is within the required range. Toxins, disinfectants, and sharps were secured and inaccessible. However, medications that Resident #1 (R1) self manages in their shared apartment was accessible to Resident #2 (R2), who is not allowed to store and administer their own medications. Violation exists. LPA observed ample two-day supply of perishables and seven-day supply of non-perishable food. LPA observed emergency food and water in the closet. The fire extinguishers were mounted, fully charged, and serviced on both levels on August 20, 2025. LPA tested the auditory devices in the residents' rooms that were available and carbon monoxide detectors were found operational on both levels. Per review of the 5 year inspection report conducted on September 4, 2024, smoke detector testing passed. Admin also indicated that fire alarm system is monitored by the company in real time evidenced by the green lights on the panel which indicated operational. The outside grounds were clear of hazards and there were sufficient seating in a shaded area. Emergency drills are conducted quarterly with the last date on September 20, 2025. The Complaint Poster (PUB475) was posted in the correct size behind the reception desk. LPA reviewed 11 resident files and four personnel files in which no discrepancies were found. Interviews were conducted with five residents and two staff. The following were advised: to ensure medications are locked in shared units if one of the resident is unable to manage their own medications and to ensure hot water temperature is regulated between 105-120 degrees Fahrenheit. Based on the observations, a deficiency is being cited, and a Technical Violation is being issued. An exit interview was conducted with Administrator Ephantus Warui, and a copy of this report including the appeal rights were provided at exit.the state’s words, verbatim · CDSS document, Sep 25, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Staff did not seek timely medical assistance. Facility force fed the resident resulting in injury

Licensing Program Analyst (LPA) conducted this unannounced complaint visit to deliver the results of the allegations above. The above allegations came in on 02/29/2024. The Department conducted an investigation into the allegations above. Resident #1 (R1) moved into the facility in January 2019. At that time R1 was ambulatory and did not need a walk or wheelchair, was able to transition to and from bed independently and needed little assistance with their Activities of Daily Living (ADLs). It was noticed on 02/05/2024 that R1 had a small cut on the left side of their face, but no bruises, it was later determined on the same day that R1 had banged their forehead on the countertop in the facility's dining room area. R1 was assessed by the Licensed Vocational Nurse (LVN) who found no injuries. Unsubstantiated On 02/19/2024, two caregivers saw R1 get up from the dining room chair, walk over to the dining room window and walk right into a chair which may have contributed to R1 banging their head on the window as they turned their head. One of the caregivers attempted to stop R1 prior to R1 walking into the chair. R1 was assessed by LVN; no bruises or marks were noted at the time. The LVN had applied an ice pack to prevent swelling. R1’s physician was notified and advised staff to keep an eye on the resident during their rounds. R1 did not complain of pain when they hit their head. On 02/24/2024, when R1 family visited, they noticed bruises on R1s forehead, they were told it was due to the incident that occurred on 02/19/2024, which they were not informed of. R1s physician was notified about the bruises and bump on R1s forehead on 02/24/2024 and advised for R1 to be sent to the hospital for an evaluation. R1 did not suffer any internal injuries requiring medical treatment. R1 was ambulatory during the time of their injury and the facility staff had acted appropriately during the incident on 02/05/2024 and on 02/19/2024, notifying the LVN and R1’s doctor. On 02/24/2024, when the bruises on R1s forehead became apparent, R1 doctor was notified immediately, and was sent out of the facility for medical evaluation. Interviews with staff stated residents have the right to refuse to eat and the do not force any resident to eat. Based on the interviews it cannot be proved or disproved Based on this interviews and records reviews, this allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are unsubstantiatedthe state’s words, verbatim · CDSS document, Jul 14, 2025 · control 22-AS-20240229081034

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87466 · Plan of correction due date: Aug 1, 2025

Observation of the Resident. The licensee shall ensure that residents are regularly observed for changes ...and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as... are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement was not met as evidence based on a review of documentation the responsible party was not notified which poses a possible health and safety risk to resident in care.the state’s words, verbatim · CDSS document, Jul 14, 2025

Plan of correction: By 08/01/2025, Licensee shall submit a written plan of correction on how they shall ensure reporting requirements are followed and incident reports are complete.

Allegation investigated: Facility staff is stealing supplies that belong to the residents.

Licensing Program Analyst (LPA) K. Hiratsuka, conducted this visit to deliver the finding for the allegation above. The department conducted interviews. Interview with a witness stated the allegation is not against this licensee. This licensee ensures there is an ample suppy of supplies needed for all the residents. Based on information above, the department concluded that the allegation is Unfounded. A finding that an allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. nothe state’s words, verbatim · CDSS document, Jul 14, 2025 · control 22-AS-20231226153724

Allegation investigated: Facility staff refused to accept resident back to the facility.

Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to deliver findings related to the investigation of the complaint allegation identified above. LPA arrived at facility and was greeted and granted entry by staff. LPA spoke with Ephantus Warui, Administrator and explained the purpose of the visit. Findings are based upon this investigation which included interviews conducted and resident file record review. It is alleged that facility staff refused to accept resident back to the facility. Interview with Administrator stated that resident (R1) had gone to the hospital on June 17, 2025. On June 18, 2025, R1 was ready to be discharged, and Administrator refused to accept R1 back to the facility. Administrator stated that they had received a call 24 hours later that R1 was ready to be discharged and Adminsitrator indicated that continued on LIC9099-C Substantiated they would not be taking R1 back until a medication assessment was completed. During the interview with Administrator allegation was confirmed. Based on information obtained R1 remained in the emergency room from June 17, 2025, to on or about June 25, 2025, until R1 responsible party found R1 new placement. During the course of the investigation, there was sufficient evidence to substantiate the allegation. The preponderance of evidence standard has been met; therefore, the above allegation is SUBSTANTIATED. See LIC9099-D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Administrator and a copy of this LIC9099 and LIC9099-D, along with a copy of the appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Jul 1, 2025 · control 22-AS-20250618153244

From the deficiency page — Deficiency type: Type B · Section cited: CCR 97224(a)(4) · Plan of correction due date: Jul 8, 2025

87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed...: (4)If, after admission, it is determined that the resident has a need to not previously identified and a reappraisal has been conducted pursuant to Section 87463, and the licensee and the person who performs the reappraisal believe that the facility is not appropriate for the resident. This requirement was not met as evidenced by: interview with Administrator stated the they refused to accept R1 back to the facility, this poses a potential risk to persons in care.the state’s words, verbatim · CDSS document, Jul 1, 2025

Plan of correction: R1 is already at a new facility. Administrator stated they will review Section cited and submit a statement of understanding, and implement written protocol steps which will assist him with eviction procedures. Administrator to send statement and written protocol to LPA by POC due date.

Allegation investigated: Staff did not dispense medication to resident as prescribed. Staff did not provide residents with adequate food service.

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on the investigation of the two allegations listed above. LPA was greeted and granted entry by front desk staff after stating the purpose of the visit. Administrator Ephantus Warui was present and assisted with the visit. The initial complaint investigation was conducted on January 31, 2025. During the visit, LPA requested and obtained the facility's current resident census as well as the list of residents under medication management. LPA requested and obtained resident records for five individuals present at the facility. Medication administration records reviewed for all five individuals. A tour of the facility's kitchen and review of the current menus conducted. CONTINUED ON FORM LIC9099-C Unsubstantiated CONTINUED ON FORM LIC9099 During the present visit, LPA requested the resident census. A review of the medication administration records, prescription orders, PRN dispensation logs and centrally stored medication was conducted for a sample of 8 residents on medication management along with an interview of the facility medication technician on duty. LPA additionally observed the lunch service being performed. Six resident interviews were also conducted during the visit. Regarding the allegation that Staff did not dispense medication to resident as prescribed, the following has been concluded: Based on interviews with staff members, review of the medication centrally stored in the medication room, review of medication administration records and resident interviews, no discrepancies between the amount stored in bubble packs and the quantities dispensed were evidenced to indicate staff failed to dispense prescribed medication timely. PRN doses are adequately being logged on sheets attached with the medication upon dispensation. Per facility policy, only doses not delivered per resident refusal or absence are being logged, with other doses assumed to be dispensed. A majority of residents interviewed stated they had no perceived issues with the assistance received for their medication self-administration Regarding the allegation that Staff did not provide residents with adequate food service, the following has been concluded: Based on staff and resident interviews along with a review of facility menus and observation of meal service in progress, it was observed that quantities and variety of food being provided were satisfactory. Residents interviewed confirmed that meal services are adequate in quantity. Seconds can be provided on demand, and accommodations are confirmed to be offered. Based on the present investigation, the allegations are found to be Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted and a copy of this report was provided to a facility representative.the state’s words, verbatim · CDSS document, Apr 18, 2025 · control 22-AS-20250124100002

Allegation investigated: Staff did not seek timely medical care for resident

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit at 8am to investigate a complaint received in our Regional Office on March 24, 2025. LPA met with Tricia Pedroza, Licensee and Ephantus Warui, Administrator and explained the purpose of the visit. LPA requested the following documents: Resident roster, Personnel Report, March care staff schedule, Unusual Incident Reports and five of five resident records for review. LPA interviewed three of three residents regarding care provided and four of four staff members regarding care given. Based on resident and staff interviews it was determined that the staff do check the resident every two hours for repositioning and as needed. Recently, the MedTech contacted 911 when the resident experienced health issues in a timely manner and the LVN texted the physician for additional orders. Resident was sent out to the hospital for further evaluation and returned with no new orders on file. (Continued on LIC 9099-C) Unsubstantiated (Continued from LIC 9099) Although the above allegation may have happened there is not a preponderance of evidence to prove the alleged violation occurred; therefore, the allegation that: Staff did not seek timely medical care for resident is unsubstantiated. An exit interview was conducted with Tricia Pedroza, LIcensee and Ephantus Wairu, Administrator and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Apr 1, 2025 · control 22-AS-20250324082636

Allegation investigated: Staff do not ensure residents call button is in reach

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit at 8am to investigate a complaint received in our Regional Office on March 24, 2025. LPA met with Tricia Pedroza, Licensee and Ephantus Warui, Administrator and explained the purpose of the visit. LPA requested the following documents: Resident roster, Personnel Report,and Unusual Incident Reports. LPA interviewed three of three residents regarding care provided and four of four staff members regarding care given. LPA toured the facility and entered five of five resident rooms and discovered one room did not have a working call button and resident was not able to reach it. At the end of the visit, call button was repaired and tested by LPA and resident's bed was moved to reach the call button on the wall. Based on LPA observations and interviews, the following deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Tricia Pedroza, Licensee and a copy of this report was given to the facility along with a copy of the LIC 9099-D and Appeal Rights. Substantiatedthe state’s words, verbatim · CDSS document, Apr 1, 2025 · control 22-AS-20250324082636

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(i)(1)(B) · Plan of correction due date: Apr 2, 2025

87303(i) Facilities shall have signal systems which... (1) All facilities licensed for 16 or more...shall have a signal system which...(B) Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. Based on LPA observation and interviews the licensee did not ensure call buttons were within reach, and in working order, in one of one resident rooms which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Apr 1, 2025

Plan of correction: The Maintenance Director immediately repaired the resident's signal system and moved the resident's bed so that the resident could reach the wall system. A cord was also in the resident's bed with a call button.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Eboni Bentley and Licensing Program Manager (LPM) Lourdes Montoya made unannounced case management visit regarding a self-reported incident on the relocation of 74 residents from Pasa Atla Holdings Corp - License # 198603295, 1790 N. Fair Oaks, Pasadena, CA 91103 to Seaside Terrace Holdings Corp-License # 306006386 due to mandatory evacuation orders from Fire Advisory. LPA and LPM met with Administrators Estefany Lopez from Pasa Alta and Ephantus “Epi” Warui from Seaside and Licensee Tricia Pedroza and explained the purpose of the visit. During the visit, LPA Bentley and LPM Montoya conducted a health and safety check and no concerns observed. LPA reviewed and obtained resident and staff rosters for both facilities, as well as Fire inspection and testing dated December 2, 2024. Per interview with the licensee, 74 residents have been relocated to Seaside Terrace. The facility has sufficient beds, hygiene supplies, beddings, linens, and everyone has a designated room. All rooms have an ensuite bathroom. The dining room is large enough to accommodate all residents with staggered dining schedules. The kitchen has sufficient two-day perishable and seven-day non-perishable food supplies. Medications, MARs, and files of the Pasa Alta residents have been transferred to Seaside Terrace and stored in a locked room. All Pasa Alta residents are fully ambulatory, use no assistance devices, and do not require any incontinent care. The Licensee stated both facilities use the same vendors, pharmacy and home health agencies, which allows them to provide the same level of continued care for the residents. The facility also has licensed LVN's on staff at Seaside Terrace to care for insulin residents. Report continued in LIC 809-C. There is sufficient staffing available to provide care for resident of both facilities. It has been verified that a routine Fire inspection and testing was completed on December 2, 2024 and a fire drill was conducted on December 12, 2024. The licensee confirmed all families, responsible parties, DMH, regional centers for the Pasa Atla residents have been notified about the relocation either via calls, texts, or emails. The licensee stated that current Seaside Terrace residents will not be affected by this relocation and will not share rooms with Pasa Alta residents. An exit interview was conducted and a copy of this report was provided to Administrator Ephantus “Epi” Warui.the state’s words, verbatim · CDSS document, Jan 8, 2025

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Staff do not ensure that residents' incontinence needs are met

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting a follow-up investigation into the allegations listed above. LPA was greeted and granted entry by administrator Ephantus Warui after stating the purpose of the visit. An initial complaint investigation visit was conducted on July 31, 2024. LPA accompanied by administrator toured the facility's physical plant. The full resident census was requested and obtained in addition to the list of residents diagnosed with incontinence in both the memory care and assisted living. The logs for incontinence changes for a total of 72 residents diagnosed with incontinence were requested, obtained and reviewed during the visit. LPA additionally requested individual assessments and physician reports for a sample of five residents across memory care and assisted living and conducted two staff interviews and two residents interviews during the visit. CONTINUED ON FORM LIC9099-C Substantiated CONTINUED FROM FORM LIC9099 During the present visit, LPA requested and obtained the current facility census and unit assignments, in addition to the list of residents for whom cash resources were being safeguarded due to the facility having been designated as the social security payee for the residents. Other residents are confirmed not to safeguard cash with the facility. One staff interview was conducted with facility administrator while twelve resident interviews were attempted or conducted. Regarding the allegation that Staff do not ensure that the facility is maintained sanitary, the following has been concluded: Based on observation conducted during two facility visits, interviews with housekeeping staff and residents, it was determined that regular housekeeping services were being provided to residents throughout the building in a satisfactory way. Excessive wear-and-tear observed in some localized areas is scheduled to be addressed by the ongoing facility remodel which was observed and verified to be continuing during both facility visits. Regarding the allegation that Staff did not assist resident with arranging transportation for medical care, the following has been concluded: While some residents decide to use transportation provided by relatives, friends or health insurance, all residents interviewed are aware of the availability of a transportation service provided by the facility. Use of the service was verified to happen during interviews. Regarding the allegation that Staff do not ensure that residents are served water free from contamination, the following has been concluded: Water jugs are placed on dining tables prior to the lunch service being initiated. However, the presence of condensation on the jugs seen during both visits evidences that the water is poured in the pitchers just shortly before the meal service, precluding the possibility of contamination. Regarding the allegation that Staff do not monitor a resident for change in condition, the following has been concluded: According to multiple residents interviewed during the present facility visit, timely and regular check-ins are being conducted by facility staff throughout the daytime and nocturnal shifts. As a result, the allegations are found to be Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred. An exit interview was conducted and a copy of this report was provided to a facility representative. CONTINUED FROM FORM LIC9099 During the present visit, LPA requested and obtained the current facility census and unit assignments, in addition to the list of residents for whom cash resources were being safeguarded due to the facility having been designated as the social security payee for the residents. Other residents are confirmed not to safeguard cash with the facility. One staff interview was conducted with facility administrator while twelve resident interviews were attempted or conducted. Regarding the allegation that Staff do not ensure that residents' incontinence needs are met, the following has been concluded: Based on interviews and records reviewed conducted during the investigation, multiple residents reported that while timely and regular checks were being conducted on residents diagnosed with incontinence of bowel and/or bladder, occasional requests for assistance went unattended for multiple hours in multiple instances on the night time shift. Administrator stated that staffing had been increased to ensure this did not occur anymore. As a result, the allegation is found to be Substantiated, meaning that the preponderance of evidence standard has been met. A type B citation is cited on an attached form LIC9099-D and cleared during the present visit. An exit interview was conducted and a copy of this report and appeal rights were provided to a facility representative.the state’s words, verbatim · CDSS document, Oct 21, 2024 · control 22-AS-20240722145330

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87625(b)(3) · Plan of correction due date: Oct 31, 2024

Per California Code of Regulations Section 87625 on Managed Incontinence: " the licensee shall be responsible for (...) (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence". This requirement is not met as evidenced by: Based on multiple interviews conducted, residents diagnosed with incontinence have reported having to wait multiple hours to get changed in some instances. This constitutes a potential risk to the health, safety and personal rights of residents in care.the state’s words, verbatim · CDSS document, Oct 21, 2024

Plan of correction: Licensee confirmed that upon change of ownership, night shift scheduling had been increased to two staff members instead of one which ensured that nocturnal wait time had been reduced significantly. Updated schedules provided, deficiency cleared.

Allegation investigated: Staff did not safeguard a resident's personal belonging

Licensing Program Analyst (LPA), Lydia Martinez conducted an unannounced visit to initiate a complaint investigation into the allegation listed above. LPA met with Administrators Tricia Pedroza and Ephantus "Epi" Warui and reason for visit was discussed. Allegation: Facility failed to safeguard resident’s personal property On or about 09/17/2024, Resident 1 (R1) returned from a Skilled Nursing facility. R1 had not noted the gym equipment that was on R1's balcony was gone. On or about 10/8/2024 when he noted gym equipment was gone, R1 reported it to AD Epi. LPA reviewed R1's file and the property log for R1. R1's property log had not been updated to reflect the gym equipment, however, interviews with Maintenance staff stated he was the one who helped R1 put together gym equipment 2+ years ago and was on R1's balcony up until it was thrown out during a clean up while R1 was out of the facility. (see LIC9099C) Substantiated Both Administrators confirmed gym equipment was thrown out by mistake when facility was going through clean up/construction couple months ago. AD Epi stated they have offered to reimbursed the resident for failing to safeguard R1's personal property (gym equipment). Based on the information gathered the preponderance of evidence standard has been met, therefore, the allegation, facility staff is not safeguarding resident's personal items, is found to be Substantiated. Violation is being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report along with citation and Appeal Rights was sent to email on file.the state’s words, verbatim · CDSS document, Oct 15, 2024 · control 22-AS-20241008150330

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87217(b) · Plan of correction due date: Oct 29, 2024

Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. This requirement was not met as evidenced by: Facility staff threw away R1's gym equipment while R1 was out. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 15, 2024

Plan of correction: Licensee to replace/reimburse R1's gym equipment and provide proof to LPA by POC due date.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Lydia Martinez conducted an unannounced Case Management to follow up on an Incident that occurred on 8/17/2024. LPA met with Licensee Tricia Pedroza and reason for visit was shared. Administrator (AD) Ephantus "Epi" Warui arrived shortly after. AD submitted LIC624A to the Regional Office (RO) email address on 8/18/2024 (copy of sent email receipt provided). RO received LIC624A on 08/20/2024. According to the report: Resident 1 (R1) was found by Staff in R1's closet with a wire hanger around R1's neck unresponsive. Based on interviews with staff, R1 was found unresponsive approximately at 07:15 am by a Housekeeper; Housekeeper reported the incident to LVN who immediately called 9-1-1. LVN began CPR per 911 Dispatcher's direction until Emergency Personnel arrived. Fountain Valley Police and Paramedics arrived, assessed R1 and pronounced R1 deceased. AD Warui and family were contacted and apprised of the incident. Orange County Coroner's office picked up the body. LPA toured the facility and reviewed R1's file. LPA was provided with a copy of R1's Physician's Report dated 6/05/24, Preplacement Appraisal dated 6/6/24, Resident Appraisal dated 6/30/24, and Individual Service Plan dated 6/12/24. LPA also obtained copies of Personnel Report and Resident Roster. LPA requested a copy of the death certificate and/or coroner's report to be submitted to CCL when available. Based on file review, observation and interviews, R1 was evaluated to need minimal assistance and was independent with the exception of R1 having medication management and care assistance when needed. No deficiencies were observed during todays visit, an exit interview was conducted with AD Warui and copy of this report was emailed at the end of visit.the state’s words, verbatim · CDSS document, Aug 21, 2024

Type of visit: Case Management - Other

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. .the state’s words, verbatim · CDSS document, Jun 17, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Sean Haddad conducted this announced inspection for the purpose of conducting a pre-licensing inspection. LPA met with Applicant (AP) Tricia Pedroza and Administrator (AD) Ephantus Warui, discussed the purpose of the inspection, and toured the facility. Facility is to operate a Residential Care Facility for the Elderly. Application was submitted to Community Care Licensing on 07/20/2023. This is a change of ownership with persons in care. During the inspection, LPA, AP, and AD observed the following: Structure: facility is a large commercial facility. There is one building with three stories. The first story contains resident rooms, offices, common areas, the kitchen, and the memory care unit with delayed egress. The second story contains resident rooms and common areas. The basement level contains parking and storage areas. There is a central open-air courtyard. The medication room is on the first floor. There are 18 bedrooms in the memory care unit and 107 bedrooms in the assisted living section. Resident rooms contain their own bathrooms. Facility telephone number is (714) 962-5531. Resident Bedrooms: the resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Lights, chairs, linens, and storage for 14 resident bedrooms inspected. Bathrooms: were clean, faucets and toilets were operational. Water temperature: tested between 105 degrees F and 118 degrees. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: 2 days perishable and 7 days nonperishable food supply reviewed. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the two housekeeping closets. Medications are locked in medication carts inside the medication room. First-Aid Kit & Activity Supplies: observed and available. Resident & Staff Files: LPA reviewed 14 resident files and 10 staff files. Fire clearance was approved by the Fountain Valley Fire Department on 09/12/2023 for 88 ambulatory, 156 non-ambulatory, and 6 bedridden. CONTINUED. Courtyard exit gates are operational and unlocked. Courtyards have shaded area for outdoor activities and sufficient seating for residents. Component III was completed with AP during today’s inspection. Facility is currently operating under the liability insurance of current facility SEASIDE TERRACE RETIREMENT COMMUNITY (306004415). AP will switch liability insurance to new facility once the application is approved. During the inspection, LPA explained the process of this application and about the post licensing inspection once the facility is licensed. AP was informed today that the facility is ready for licensure and final approval will be processed by the CAB supervisor in Sacramento. An exit interview was conducted and a copy of this report was discussed with and provided to AP.the state’s words, verbatim · CDSS document, Nov 15, 2023