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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005604
Report Date: 11/22/2021
Date Signed: 11/22/2021 12:23:27 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SEA CLIFF ASSISTED LIVINGFACILITY NUMBER:
306005604
ADMINISTRATOR:JANICE MCALISTERFACILITY TYPE:
740
ADDRESS:18851 FLORIDA STTELEPHONE:
(714) 847-3999
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY:84CENSUS: 34DATE:
11/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:46 AM
MET WITH:Administrator, Pamela JongeTIME COMPLETED:
12:35 PM
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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted, granted entry into the facility and temperature was checked at front desk. LPA explained reason for visit.

During the visit LPA toured the facility with Administrator Pamela Jonge. Facility is a two story, 42 units facility. There are 34 Residents in care. LPA observed proper covid signage at front entrance of facility. At front receptionist desk there is a visitor check in. Facility has required Department postings. LPA toured Facility lobby, dining room, kitchen, storage room, resident rooms and medication room. Resident rooms observed where within department regulations. All restrooms observed contained soap, toilet paper, and hand towels. Residents were observed playing bingo socially distanced in dining room. Facility has operating smoke detectors and audible alarms which LPA observed Last fire inspection paperwork was completed on June 28, 2021. Facility has 4 fire extinguishers, (2 on each floor) all which were observed as fully charged. LPA observed facility has emergency food and water supply. Facility has a secured location for resident medication and files. LPA observed residents medications and facility has 30 days supply of medications for Residents. LPA reviewed 4 Residents files during visit. Residents emergency contact information and Physicians reports are current. Facility has several designated visitation areas.

No deficiencies noted during todays visit. An exit interview was conducted with Administrator and a copy of report was left at facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2021
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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