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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006146
Report Date: 01/19/2023
Date Signed: 01/19/2023 02:20:25 PM


Document Has Been Signed on 01/19/2023 02:20 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
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: 43DATE:
01/19/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Taylor ClarkTIME COMPLETED:
02:35 PM
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of following up on a recent change in capacity. LPA met with Administrator (AD) Taylor Clark and explained the purpose of the inspection.

Facility previously had a fire clearance for a non-ambulatory capacity of 22. Per Fire Clearance approved by Huntington Beach Fire Department Inspector Shannon Sanders on 01/04/2023, the facility is now approved for a non-ambulatory capacity of 44 all of which must be on the first floor. During the inspection, LPA and AD toured the facility and confirmed that the rooms designated as non-ambulatory are on the first floor. LPA reviewed the Physician’s Reports of 5 residents on the second floor and confirmed they are ambulatory. During the inspection, LPA delivered the facility’s updated license.

There were no health and safety concerns observed in the areas inspected. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2023
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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