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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006746
Report Date: 08/26/2025
Date Signed: 08/26/2025 02:26:50 PM

Document Has Been Signed on 08/26/2025 02:26 PM - 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:BEACH TERRACE ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
306006746
ADMINISTRATOR/
DIRECTOR:		CHON,CHRISTINEFACILITY TYPE:
740
ADDRESS:12282 BEACH BLVDTELEPHONE:
(714) 694-3205
CITY:STANTONSTATE: CAZIP CODE:
90680
CAPACITY: 120CENSUS: 60DATE:
08/26/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Christine ChonTIME VISIT/
INSPECTION COMPLETED:
02:35 PM
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Licensing Program Analysts (LPA) Jerome Haley made an announced visit for the purpose of conducting a pre-licensing evaluation. LPA Haley was greeted and granted entry by Executive Director Christine Chon.

Initial application: To operate a Residential Care Facility Elderly/Dementia (RCFE), with a capacity of 120, of which 120 may be bedridden and waiver granted for Hospice (20) was submitted to the department for licensure.


Fire clearance: Orange County Fire Authority granted the Fire Clearance May 13, 2025.
Structure:
The facility is a three-level structure with a total of 66 bedrooms for residents in care. All resident rooms are on the second and third floor. Assisted Living (AL) residents are located on the second floor and Memory Care (MC) residents are on the third floor. Bedrooms: All bedrooms have the required furnishings: bed, lamp, chair, and storage space. Bathroom(s): Bathrooms are equipped with a working toilet, wash basin, and shower. Non-skid surface and grab bars were observed. Two public bathrooms are located on each floor.
Kitchen: The kitchen is clean, well organized and remains locked and inaccessible to residents. Sharps are located in a drawer. LPA observed a large commercial oven that was being used, a commercial refrigerator/freezer. LPA observed an emergency supply of food and water. The main kitchen is on the first floor, and there are two smaller kitchens, one on the second floor and one on the third floor. During meal times the food is brought over from the main kitchen to one of the smaller kitchen areas to be served to the residents on that floor.
Food Service: Food deliveries are made twice a week by Cisco. During the inspection LPA observed a perishable and nonperishable food supply that meets regulation requirements.

Continued on LIC809C page: 1 of 3
NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Jerome Haley
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2025
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 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: BEACH TERRACE ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 306006746
VISIT DATE: 08/26/2025
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Garage/Parking Area: A covered parking structure is available for staff and authorized visitors when there is no more visitor parking is available. Visitor parking is available in front of the building.

Toxins: All toxic chemicals, soaps, detergents, and cleaning solutions were observed in locked rooms (kitchen, laundry room) and inaccessible to residents in care.

Client & Staff Files: Staff and resident files are stored on the first floor in the business office.

Medications/First-Aid Kit: The med room is located on the third floor. The med room remains locked and inside the locked med room, LPA observed three medication carts, incontinent supplies and resident’s medical files. LPA observed three first aid kits that meet regulation requirements. One first aid kit on each floor.

Linens & Hygiene Supplies: Hygiene items were observed in resident bathrooms, and the facility keeps a supply of clean linens to use as back up and in case of emergency.

Exterior: Residents have access to two outside areas located on the second floor. Outside walkways are clear and free of obstruction. Table with sunshade and chairs were observed. No bodies of water observed.

Laundry: There are two laundry rooms available. One on the second floor and one on the third floor. Residents are on a laundry schedule, but the AL residents can use the laundry room as needed.

Smoke/Carbon Monoxide Detectors: Sprinkler and fires systema check are checked by AV Com and are inspected quarterly.
Fire Extinguisher: Multiple Fire extinguishers were observed mounted on the walls throughout the facility.

Emergency Phone Numbers, House Rules, Exit Plan & Menu:
Facility postings were observed in the front lobby on the front desk and on the desk right behind the reception desk.

Continued on LIC812C page: 2 of 3
NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Jerome Haley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: BEACH TERRACE ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 306006746
VISIT DATE: 08/26/2025
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Additional Comments: The facility telephone number is: 714.694.3205, the secondary number is 657.724.9844, and the facility email address is 14730enterprise@gmail.com and was confirmed during the visit. Activities items were observed including arts and crafts items, and musical entertainment for the residents to enjoy.

Component III: Component III was not presented as the facility has one correction to make. A follow up visit will be scheduled.

Corrections Needed:
· Hot water temperature – Hot water needs to be slightly adjusted to meet regulation guidelines.

An exit interview was conducted, and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Jerome Haley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4