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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006746
Report Date: 09/08/2026
Date Signed: 09/08/2026 05:27:44 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/08/2026 05:27 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:		MINYOUNG KIMFACILITY TYPE:
740
ADDRESS:12282 BEACH BLVDTELEPHONE:
(714) 694-3205
CITY:STANTONSTATE: CAZIP CODE:
90680
CAPACITY: 120CENSUS: 73DATE:
09/08/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Minyoung Kim, John YoonTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Michael Tea conducted an unannounced Annual Required inspection of the facility. Upon arrival, LPA Tea was greeted and granted entry by Administrator (AD) Minyoung Kim and Operations Director (OD) John Yoon. LPA explained the purpose of the visit. The facility is licensed to serve 120 non-ambulatory residents, of which 120 may be bedridden, and has a hospice waiver for twenty (20) residents. At the time of the visit, the facility had a census of 73 residents, of which two (2) were receiving hospice services.

LPA Tea reviewed seven (7) resident files and five (5) staff files. The residents and staff files reviewed contained the required documentation. AD Kim's Administrator Certificate is current and valid through May 28, 2028.

LPA Tea, accompanied by AD Kim and OD Yoon, toured the physical plant, including resident living areas, common areas, food service areas, and outdoor spaces. The facility is a three-story building. The first floor consists of the reception lobby, administrative offices, and kitchen. The second floor serves assisted living residents, and the third floor serves memory care residents. The facility has outdoor terraces located on both sides of the building with adequate shaded seating available for residents. LPA tested the delayed-egress system on the second floor and observed it to be operational.

The facility's fire alarm system is monitored and maintained by a third-party company. Fire extinguishers throughout the facility were observed to be fully charged. LPA also observed evacuation chairs located in the stairwells on each floor for emergency use. The facility's most recent disaster drill was conducted on June 19, 2026.

(Annual Inspection continued on LIC809-C)

Lourdes Montoya
Michael Tea
DATE: 09/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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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: 09/08/2026
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Resident bedrooms were observed to have the required furniture, bed linens, and adequate closet and drawer space to accommodate residents. During the room tours, LPA observed bed rails installed on resident beds. LPA reminded facility management that bed rails require appropriate written orders and documentation. Facility staff removed the bed rails for residents who did not have the required documentation and stated that written orders would be obtained, as applicable. Resident bathrooms were inspected and observed to be clean and in good repair. Toilets and faucets were operational, grab bars were secure, and showers were free of visible mold and mildew. Hot water temperatures measured between 105.3 and 105.6 degrees Fahrenheit.

LPA activated an emergency call pendant located in a resident bathroom, and facility staff responded within three (3) minutes. LPA also tested a resident push-button pendant, and facility staff responded within one (1) minute. Common areas were observed to be clean and free of apparent hazards. Doorways, hallways, and passageways were observed to be free of obstructions.

LPA inspected the kitchen and dining areas. The facility had an adequate supply of perishable and nonperishable food available at the time of the visit. Menus were posted throughout the facility, and residents were provided with a variety of meal options, including Western and Korean food. An emergency supply of drinking water and food was observed in the kitchen storage area.

LPA Tea reviewed the facility's medication storage and administration practices. Medications were observed to be stored in locked medication carts in the medication room located on the third floor. During the medication review, medications reviewed were being administered in accordance with physicians' orders. LPA also inspected the first aid kit located in the medication room and observed that it contained the required supplies. LPA interviewed residents regarding the quality of care and services provided by the facility and spoke with staff regarding resident care. During the visit, LPA observed residents participating in leisure activities, including watching Korean programming and other variety shows. Activity schedules were posted throughout the facility.

Based on observations, interviews, and records reviewed during today's inspection, a deficiency is being cited in accordance with Title 22, Division 6, Chapter 8 of the California Code of Regulations.

An exit interview was conducted with Administrator Minyoung Kim. The deficiency, Plan of Correction, and appeal rights were reviewed with the facility. A copy of this report, LIC809D, LIC858, LIC859, and Appeal Rights was provided to the facility at the time of exit.

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Michael Tea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 09/08/2026 05:27 PM - It Cannot Be Edited


Created By: Michael Tea On 09/08/2026 at 05:01 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: BEACH TERRACE ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 306006746

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/09/2026
Section Cited
CCR
87609(a)(3)

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Postural Supports (a)(3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by:
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LPA advised the facility that appropriate documentation authorizing the use of bed rails must be maintained in each applicable resident's file. During the visit, staff removed the bed rails from residents who did not have the required authorization or documentation on file.
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During the physical plant tour, LPA observed residents with bed rails without physician orders supporting their use. The unauthorized use of bed rails poses an immediate health and safety 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.
Lourdes Montoya
NAME OF LICENSING PROGRAM MANAGER:
Michael Tea
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2026


LIC809 (FAS) - (06/04)
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