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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005495
Report Date: 01/22/2026
Date Signed: 01/22/2026 04:38:27 PM

Substantiated


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
01/16/2026 and conducted by Evaluator Fred Arias
COMPLAINT CONTROL NUMBER: 22-AS-20260116113625
FACILITY NAME:BEACH HOMES IIIFACILITY NUMBER:
306005495
ADMINISTRATOR:BEACH, ANDYFACILITY TYPE:
740
ADDRESS:2336 COLLEGE DRTELEPHONE:
(714) 549-1905
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY:6CENSUS: 6DATE:
01/22/2026
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Andy BeachTIME COMPLETED:
04:51 PM
ALLEGATION(S):
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Facility failed to arrange appropriate medical care after resident fell and hit their head.
INVESTIGATION FINDINGS:
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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
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 22-AS-20260116113625
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: BEACH HOMES III
FACILITY NUMBER: 306005495
VISIT DATE: 01/22/2026
NARRATIVE
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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.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20260116113625
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: BEACH HOMES III
FACILITY NUMBER: 306005495
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/22/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
01/29/2026
Section Cited
CCR
87466
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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...
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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.
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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.
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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.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3