<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006146
Report Date: 06/01/2023
Date Signed: 06/01/2023 01:53:50 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 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
04/17/2023 and conducted by Evaluator Jenifer Tirre
COMPLAINT CONTROL NUMBER: 22-AS-20230417081445
FACILITY NAME:SEA CLIFF ASSISTED LIVINGFACILITY NUMBER:
306006146
ADMINISTRATOR:CLARK, TAYLORFACILITY TYPE:
740
ADDRESS:18851 FLORIDA STREETTELEPHONE:
(714) 847-3999
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY:84CENSUS: 42DATE:
06/01/2023
UNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Administrator Taylor ClarkTIME COMPLETED:
02:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Insufficient staffing to meet resident needs.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jenifer Tirre met with Executive Director Taylor Clark for the purpose of delivering findings for the above allegations. The investigation consisted of Observations and interviews with Sea Cliff Assisted living staff & residents. The investigation also consisted of obtained facility records.
On 4/17/2023 the department received allegations that facility had insufficient staffing to meet resident needs and facility is unsanitary. The investigation was completed by the department and revealed the following:

Based off interviews with residents, five out of six residents confirmed that facility has sufficient staffing per shift. Most residents stated when requiring assistance, staff is easy to contact as well as staff check in on residents every two hours. Interviews with staff revealed that five out of five staff confirmed that facility does not have staffing shortage. Staff interviews confirm that facility has two caregivers, one med tech and one housekeeper during shift. Facility Personnel Report dated 04/21/2023 confirms that Facility has one med tech and three caregivers during morning shift of 7:00am to 3:00pm, two med tech’s and three caregivers during Mid shift 3:00pm to 11:00pm and CONTINUED ON 9099C
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023
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-20230417081445
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
VISIT DATE: 06/01/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
two med tech’s and one caregiver during Noc shift 11:00pm to 7:00am. Personnel Report reveals that two staff members cover job scope of both Med Tech and Caregivers and two house keepers are present between the hours of 9:00am to 5:00pm. Based off information obtained this agency has investigated the complaint alleging Insufficient staffing to meet resident needs. We have found that the complaint was UNFOUNDED , meaning that the allegation was false, could not have happened and or is without a reasonable basis.

An exit interview was conducted with Executive Director and a copy of this report along with a copy of appeal rights was provided to facility.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023
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 & INLAND A/SC, 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
04/17/2023 and conducted by Evaluator Jenifer Tirre
COMPLAINT CONTROL NUMBER: 22-AS-20230417081445

FACILITY NAME:SEA CLIFF ASSISTED LIVINGFACILITY NUMBER:
306006146
ADMINISTRATOR:CLARK, TAYLORFACILITY TYPE:
740
ADDRESS:18851 FLORIDA STREETTELEPHONE:
(714) 847-3999
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY:84CENSUS: 42DATE:
06/01/2023
UNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Administrator Taylor ClarkTIME COMPLETED:
02:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is unsanitary.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jenifer Tirre met with Executive Director Taylor Clark for the purpose of delivering findings for the above allegations. The investigation consisted of Observations and interviews with Sea Cliff Assisted living staff & residents. The investigation also consisted of obtained facility records.
On 4/17/2023 the department received allegations that facility had insufficient staffing to meet resident needs and facility is unsanitary. The investigation was completed by the department and revealed the following:

Based off interviews with residents, all residents interviewed confirmed staff cleans rooms twice a day and tidying up daily meaning throwing trash out and making beds. Interviews with staff confirm that facility house keeping cleans rooms daily and deep cleaning every 10 days. Observations noted during investigation revealed that on two separate dates rooms were observed for cleanliness. On 4/25/23 LPA observed three out of five rooms were cleanly in appearance. On 5/16/23 LPA observed four out of six rooms were cleanly and needed minor tidying.
CONTINUED ON 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023
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-20230417081445
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
VISIT DATE: 06/01/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based off information gathered although the allegation Facility is unsanitary may have happened or is valid , there is no preponderance of evidence to prove the alleged violation did or did not occur , therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted with Executive Director and a copy of this report along with a copy of appeal rights was provided to facility.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4