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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306006146
Report Date:
05/16/2023
Date Signed:
05/16/2023 03:47:22 PM
Document Has Been Signed on
05/16/2023 03:47 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
ORANGE & INLAND A/SC
,
770 THE CITY DR., SUITE 7100
ORANGE
,
CA
92868
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:
42
DATE:
05/16/2023
TYPE OF VISIT:
Collateral
UNANNOUNCED
TIME BEGAN:
02:30 PM
MET WITH:
Administrator, Taylor Clark
TIME COMPLETED:
04:00 PM
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On this day Licensing Program Analyst (LPA) Jenifer Tirre and Licensing Program Manager (LPM) Alisa Ortiz made an unannounced visit for the purpose of conducting a collateral visit in regards to open complaint investigations unrelated to current licensee. LPA and LPM met with Administrator Taylor Clark and explained reason for the visit
On this day LPA and LPM conducted interviews and gathered pertinent records related to complaint control numbers:
22-AS-20220608163536
22-AS-20211220113154
22-AS-20211118161629
22-AS-20211022104111
22-AS-20210907125211
22-AS-20210108092129
22-AS-20200721114435
Exit interview conducted with Administrator and copy of report was provided to facility.
SUPERVISOR'S NAME:
Luz Adams
TELEPHONE:
(714) 222-3812
LICENSING EVALUATOR NAME:
Jenifer Tirre
TELEPHONE:
(714) 401-6844
LICENSING EVALUATOR SIGNATURE:
DATE:
05/16/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/16/2023
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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