306006146-10-23-2025-22-AS-LMOA-DPHVAT-20251219151628

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006146
Report Date: 10/23/2025
Date Signed: 10/23/2025 04:41:22 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
08/06/2025 and conducted by Evaluator Edward Kim

COMPLAINT CONTROL NUMBER: 22-AS-20250806104200

FACILITY NAME:	SEA CLIFF ASSISTED LIVING		FACILITY NUMBER:	306006146
ADMINISTRATOR:	CLARK, TAYLOR		FACILITY TYPE:	740
ADDRESS:	18851 FLORIDA STREET		TELEPHONE:	(714) 847-3999
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92648
CAPACITY:	84	CENSUS: 63	DATE:	10/23/2025
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Administrator- Taylor Clark		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility is understaffed.

INVESTIGATION FINDINGS:

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On October 23, 2025, Licensing Program Analyst (LPA) Edward Kim conducted a subsequent complaint visit to deliver complaint investigation findings. LPA met with Executive Director (ED) Taylor Clark and explained the purpose of today’s visit.

The investigation consisted of the following: LPA Kim toured the facility with ED Taylor Clark. LPA Kim requested and obtained copies of the Resident and Staff Rosters, Plan of Operation, Staffing Schedule, Staffing Ratio Record, and other pertinent documentation. LPA conducted interviews with five residents and six staff.

The investigation revealed the following:

Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025

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

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20250806104200

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: 306006146
	VISIT DATE: 10/23/2025

NARRATIVE

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Allegation: Facility is understaffed
It is alleged that there are three caregivers in the morning shift, but there needs to be at least four caregivers.
Based on interviews conducted, six out of six staff denied the allegation. All staff stated staffing levels are good and sufficient care is being provided. S1 and S2 stated that the 1st shift (AM Shift) and the 2nd Shift (PM Shift) has three caregivers, one medication technician, Wellness Director, and Executive Director available. They also stated the Nocturnal Shift (NOC) has one medication technician and one caregiver. This was corroborated based on record review, where the facility weekly schedule shows three caregivers and one medication technician for the 1st Shift (AM Shift) and 2nd shift (PM Shift), and one caregiver and one medication technician for NOC shift. This was also corroborated based on LPA’s observations on August 28, 2025, LPA Edward Kim observed 3 caregivers and 1 medication technician at the facility with 60 residents present. On October 23, 2025, LPA observed three caregivers, medication technician, Wellness Director, and Executive Director at the facility with 63 residents present.

Based on record review The Sea Cliff Assisted Living Staffing Ratio Record which is called Staffing Ladder details a ratio between the census number with the different shifts and the number of staff required in a table chart. On August 28, 2025, the census was at 60 residents and on October 23, 2025, the census was at 63 residents. The Staffing Ladder ratio lists the following per shift for the census at 60-63 residents: morning shift needs 3 caregivers, 1 medication technician, and 2 housekeepers; afternoon shift needs 3 caregivers and 1 medication technician; and night shift needs 1 caregiver and 1 medication technician. This corroborates S1 and S2 interview, Facility weekly schedule, and LPA’s observations.

S1 and S2 also stated that if any caregiver calls out that the Executive Director, Wellness Director, and Medication Technician are expected to help provide care for the residents. In addition to that, the facility will call staff and/or an agency to cover unplanned absences.

Based on interviews conducted, four residents stated that the facility is understaffed because the facility does not respond in a timely manner whenever a call light is pressed. LPA observed in two resident rooms that when call lights were pressed, the facility staff responded in a timely manner. Based on Information gathered, there is no sufficient evidence to corroborate the above allegation.
Continued on LIC9099C

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20250806104200

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: 306006146
	VISIT DATE: 10/23/2025

NARRATIVE

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Based on records review, interviews, and observations, LPA did not find sufficient evidence to support the above allegation. 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 Unsubstantiated.

An exit interview was conducted, and a copy of this report was provided to the Executive Director Taylor Clark.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025

LIC9099 (FAS) - (06/04)

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