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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006386
Report Date: 10/30/2025
Date Signed: 10/30/2025 05:25:01 PM

Unsubstantiated


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
10/23/2025 and conducted by Evaluator Eboni Bentley
COMPLAINT CONTROL NUMBER: 22-AS-20251023114754
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: 161DATE:
10/30/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Ephantus Warui- Administrator TIME COMPLETED:
05:20 PM
ALLEGATION(S):
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Facility is not sanitary.
INVESTIGATION FINDINGS:
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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
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
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 2
Control Number 22-AS-20251023114754
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: 10/30/2025
NARRATIVE
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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.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2