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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006146
Report Date: 06/22/2022
Date Signed: 06/22/2022 10:57:59 AM


Document Has Been Signed on 06/22/2022 10:57 AM - It Cannot Be Edited

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:
306006146
ADMINISTRATOR:ROCHE, RYANFACILITY TYPE:
740
ADDRESS:18851 FLORIDA STREETTELEPHONE:
(714) 847-3999
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY:84CENSUS: 34DATE:
06/22/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Wellnes Director, Taylor ClarkTIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Jenifer Tirre made an announced pre-licensing visit to follow up on corrections identified during visit on 06/15/2022. LPA identified themselves and discussed the purpose of the visit with Wellness Director Taylor Clark. An initial application to operate a Residential Facility Care for the Elderly was submitted to CCL on 02/11/2022. There are 34 residents in care during today's visit. LPA observed facility is following covid precaution guidelines.

At 10:20 AM LPA toured the facility and observed the following:

· Water temperature measured between 106.3 and 119.8 degrees F. in facility restrooms

· Facility Staff files were in a secure location in Wellness Director office

  • Let Us Know sign was located near entrance in correct size 20 x26

All noted items from visit on 06/15/2022 have been addressed.
The facility is ready to be licensed.

An exit interview was conducted with Wellness Director and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2022
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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