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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006386
Report Date: 01/08/2025
Date Signed: 01/10/2025 11:45:04 AM

Document Has Been Signed on 01/10/2025 11:45 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SEASIDE TERRACEFACILITY NUMBER:
306006386
ADMINISTRATOR/
DIRECTOR:		PEDROZA, TRICIAFACILITY TYPE:
740
ADDRESS:9925 LA ALAMEDA AVETELEPHONE:
(714) 962-5531
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY: 250CENSUS: 224DATE:
01/08/2025
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
05:30 PM
MET WITH:Administrators Estefany Lopez from Pasa Alta and Ephantus “Epi” Warui from Seaside and Licensee Tricia Pedroza TIME VISIT/
INSPECTION COMPLETED:
07:30 PM
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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.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: SEASIDE TERRACE
FACILITY NUMBER: 306006386
VISIT DATE: 01/08/2025
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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.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
LIC809 (FAS) - (06/04)
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