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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006146
Report Date: 01/24/2025
Date Signed: 01/24/2025 12:32:35 PM

Unfounded


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
01/17/2025 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250117163013
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: 51DATE:
01/24/2025
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Taylo Clark - Administrator TIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Due to neglect, resident's health declined
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Jerome Haley made an unannounced visit regarding the complaint allegation above. LPA Haley was greeted by staff and explained the reason for the visit upon entry. Before interviews began, LPA toured the interior and exterior patio area of the facility with staff. Staff led LPA Haley to the portion of the Skilled Nursing Facility (SNF) to observe the main kitchen area.

Regarding the complaint allegation: Due to neglect, resident's health declined

During the investigation, 3 of 4 individuals were successfully interviewed and all three provided information that contradicted the complaint allegation.

During an interview with Witness 1 (W1), the witness explained they received an inquiry from a child of Resident 1 (R1) who wanted to R1 to stop taking a medication.

Continued on LIC9099C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
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 2
Control Number 22-AS-20250117163013
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: 01/24/2025
NARRATIVE
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W1 explained to the family member that it would not be good to suddenly stop administering the medication and suggested weaning R1 of the medication and the child agreed. However, R1’s other child, Witness 2 (W2) contacted W1 and provided W1 a Medical Power of Attorney (POA) and requested to stop providing medications to R1. At that time W1 went over all the options available to W2, including weaning R1 off medications, Hospice services which W2’s version of Hospice did not match W1’s version of hospice, so W1 explained their only other option was hospitalization.

During interviews with Staff 1 (S1) and Staff 2 (S2), both staff members explained they would not comply with a family members request to administer, stop administering, or change the dose of a residents medication. Both staff members explained there must be a doctors order before a medication adjustment can be made.

A review of R1's documents show, medications were discontinued, and dosages were lowered at the request of R1's family.

During the visit several documents were provided and S1 agrees to email LPA any addition documents needed.

Based on the information gathered through interviews and document review, the following allegation: Due to neglect, resident's health declined, is deemed unfounded, meaning the allegation is false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2