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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006386
Report Date: 10/07/2025
Date Signed: 10/07/2025 05:11:02 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
09/29/2025 and conducted by Evaluator Eboni Bentley
COMPLAINT CONTROL NUMBER: 22-AS-20250929134237
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: 159DATE:
10/07/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Tricia Pedroza - LicenseeTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Illegal eviction
INVESTIGATION FINDINGS:
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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
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
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-20250929134237
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: SEASIDE TERRACE
FACILITY NUMBER: 306006386
VISIT DATE: 10/07/2025
NARRATIVE
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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.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20250929134237
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: SEASIDE TERRACE
FACILITY NUMBER: 306006386
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/08/2025
Section Cited
CCR
87224(a)
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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:
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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.
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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.
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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: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
LIC9099 (FAS) - (06/04)
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