306005604-9-26-2023-22-AS-AORZ-CWKN6P-20231013101127

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005604
Report Date: 09/26/2023
Date Signed: 09/26/2023 09:54:14 AM

Unfounded

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
07/21/2020 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200721114435

FACILITY NAME:	SEA CLIFF ASSISTED LIVING		FACILITY NUMBER:	306005604
ADMINISTRATOR:	MARION, MICHAEL		FACILITY TYPE:	740
ADDRESS:	18851 FLORIDA ST		TELEPHONE:	(714) 847-3999
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92648
CAPACITY:	0	CENSUS: 0	DATE:	09/26/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:			TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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Staff unable to meet residents needs resulting in wounds and scars on right hip

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jenifer Tirre attempted contacting Licensee for the purpose of delivering the findings on a complaint investigation via telephone due to facility Change of ownership on 7/6/2022. The investigation consisted of interviews with Sea Cliff Assisted Living staff and residents and a review of records obtained.

During course of the investigation, the investigation found the following:
It was alleged staff were unable to meet Resident 1 (R1) needs resulting in wounds and scars on right hip. R1 was admitted to the facility on February 14, 2020. Per R1’s needs and service plan dated February 28, 2020 R1 is able to ambulate independently with a walker but prefers a wheelchair as a primary mode of transportation. R1 can independently complete all activities of daily living except for showering. R1 is listed as requiring only a one-time bed safety check per night.
On or about July 13, 2020 R1 was admitted to the hospital for vomiting and nausea. At the time of being admitted hospital staff observed R1 to have... CONTINUED ON 9099C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

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 4

Control Number 22-AS-20200721114435

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: SEA CLIFF ASSISTED LIVING	FACILITY NUMBER: 306005604
	VISIT DATE: 09/26/2023

NARRATIVE

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seven wounds and a scar on their right hip. R1 told hospital staff the scar was from a heating pad and the wound on her neck from her vomiting. R1 was reported to have been bed bound for the last month and was using an adult diaper for incontinence needs. R1 told hospital staff the facility staff visit 3-4 times a day to assist with incontinence and turn her in bed but when calling for help it can take up to 45 minutes to 2 hours to respond.

Records obtained from the facility include a letter written by R1’s responsible party dated July 30, 2020 stating they were happy with the facility’s care and treatment for R1 and that R1’s hospitalization had nothing to do with lack of care but was instead due to severe hip pain. R1’s physician report obtained dated February 13, 2020 diagnoses R1 with Myotonic dystrophy and diabetes. The physician report further states R1 has no known history of skin conditions or breakdowns and is not bedridden. R1 is able to follow instructions and communicate needs. R1’s needs and service plan was updated on June 27, 2020 to include assistance with daily grooming. The service plan maintains that R1 is mobile with a wheelchair assistance and not bedridden. The service plan states meal trays were initiated at R1’s request. Following R1’s hospitalization, Home Health was initiated on 7/29/2020 for a pressure injury to the heel. However, R1 did not return to the facility per R1’s responsible party’s letter due requiring skilled level of care. Incident report dated 7/13/2020 confirms R1’s hospitalization due to weakness and vomiting. Incident report dated 5/29/2020 confirms R1 was hospitalized as a result of severe hip pain.

Interviews conducted with hospital social workers confirmed scars observed were inches wide and scabbed over due to burns from a sitting too long on a heating pad. The social worker acknowledged that R1 had the capacity to know better but continued to do it anyway. Staff interviewed at the facility confirmed observing R1 having a heating pad in their room.

Although R1 was observed to have wounds, the wounds appeared to be self inflicted and not a result of not meeting R1’s needs. Therefore, based on the preponderance of evidence the allegation Staff unable to meet residents needs resulting in wounds and scars on right hip is deemed to be UNFOUNDED, meaning the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

The facility has had a change of ownership effective 7/6/2022 . Attempts to reach Licensee Beach City Senior Living LLC. to conduct an exit interview were unsuccessful. A copy of this report will be certify mailed to the Licensee’s last known address.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
07/21/2020 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200721114435

FACILITY NAME:	SEA CLIFF ASSISTED LIVING		FACILITY NUMBER:	306005604
ADMINISTRATOR:	MARION, MICHAEL		FACILITY TYPE:	740
ADDRESS:	18851 FLORIDA ST		TELEPHONE:	(714) 847-3999
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92648
CAPACITY:	0	CENSUS: 0	DATE:	09/26/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:			TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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Staff not responding to resident in timely manner when call for help

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jenifer Tirre attempted contacting Licensee for the purpose of delivering the findings on a complaint investigation via telephone due to facility Change of ownership on 7/6/2022. The investigation consisted of interviews with Sea Cliff Assisted Living staff and residents and a review of records obtained.

During course of the investigation, the investigation found the following:

On or about July 13, 2020 R1 was admitted to the hospital for vomiting and nausea. At the time of being admitted hospital staff observed R1 to have seven wounds and a scar on their right hip. R1 told hospital staff the scar was from a heating pad and the wound on her neck from her vomiting. R1 was reported to have been bed bound for the last month and was using an adult diaper for incontinence needs. R1 told hospital staff the facility staff visit 3-4 times a day to assist with incontinence and turn her in bed but when calling for help it can take up to 45 minutes to 2 hours to respond. CONTINUED ON 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 22-AS-20200721114435

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: SEA CLIFF ASSISTED LIVING	FACILITY NUMBER: 306005604
	VISIT DATE: 09/26/2023

NARRATIVE

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Staff reported they check residents every 1 to 2 hours depending on their needs but do not keep a record of checks. Pull cord records provided by former Administrator Mike Marion for resident rooms notes multiple instances where pull cord was not resolved for a duration of over an hour and majority of the calls were resolved due to no response. However, former Administrator Mike Marion reported the call logs were having errors and denied that the response call times were correct noting he believed that the long waits were primarily explained by improper resetting of the call lights. In an effort to address the call log error, the former Administrator self initiated a staff in service on call light policy and monthly audits of the call lights by Maintenance. Interviews with residents reported staff arrived to rooms varying from anywhere between 5 to 30 minutes in response to staff response times.

Based on records reviewed and interviews conducted, the allegation Staff not responding to resident in timely manner when call for help is determined to be UNSUBSTANTIATED, meaning although the allegation may have happened, or is valid there is no preponderance of evidence to prove the alleged violation did or did not occur.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4