306006146-1-9-2025-22-AS-MSTC-DDG5RX-20250131191152

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006146
Report Date: 01/09/2025
Date Signed: 01/09/2025 11:22:08 AM

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
01/02/2025 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20250102143150

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: 58	DATE:	01/09/2025
		UNANNOUNCED	TIME BEGAN:	08:25 AM
MET WITH:	Taylor Clark		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff administered medication to resident without authorized representative consent

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Jospeh Alejandre and Brandon Lopez made an unannounced visit to conduct the required 10-day visit to begin the investiation into the allegation listed above. LPAs met with Administrator Taylor Clark and explained the reason for the visit. The investigation revealed the following. Resident 1 (R 1) moved into the assisted living facility on June 26, 2023. After R1 moved in, a family member (F1) provided a completed medical power of attorney (POA) dated August 9, 2022 making F1, R1's agent in all matters relating to health care. The Administrator reported that in May 2024 R1 was put on medications after a doctor's visit and F1 agreed. F1 could not be reached to verify this information. R1 continued taking medications and residing at the facility until November 8, 2024 after suffering a fall. R1 was sent to the hospital and from the hospital transferred to a skilled nursing facility (SNF) on November 13, 2024. R1 remained at the SNF until they were discharged to the assisted living facility on January 6, 2025. It was reported that F1 wanted all medications stopped when R1 returned to the assisted living facility. The Adminsitrator reported that the physician's at the SNF had already begun to taper R1's medications at F1's request.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

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-20250102143150

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: 01/09/2025

NARRATIVE

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The Administrator reported that the physicians informed him that stopping the medications for R1 all at once is unsafe. The Administrator reported that R1's medications are being reduced in accordance with doctor's orders because of F1's request to have all medications discontinued. The Administrator reported they are complying with F1's requests while at the same time doing it in accordance with the physician's orders to reduce the medication safely. The Administrator reported that R1 has an appointment with a Nurse Practitioner on January 9, 2025 to evaluate R1 and her medications. A review of records shows R1 was receiving 9 medications at the SNF and currently at the assisted living facility R1 is receiving 6 medications. R1's Risperidone has been reduced from .75 mg at the SNF to .5 mg at the assisted living facility. During the time period from November 8, 2024 until January 6, 2025, R1 was not in the care of the assisted living facility and they had no control over R1's medications. When R1 moved back to the facility on January 6, 2025 the facility followed the medical advise of physicians in regards to getting R1 off of medications in a safe manner to comply with F1's request. There is insufficient evidence to support the allegation. Although the allegation may have happened or is valid; there is not a preponderance of evidence to prove that the alleged violation did or did not occur, therefore the allegation, staff administered medication to resident without authorized representative consent, is unsubstantiated. An exit interview was conducted and a copy of the report provided.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

LIC9099 (FAS) - (06/04)

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