306006146-6-19-2023-22-AS-AORZ-CT8JSF-20230628071812

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006146
Report Date: 06/19/2023
Date Signed: 06/19/2023 01:54:11 PM

Unsubstantiated

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
02/13/2023 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230213095348

FACILITY NAME:	SEA CLIFF ASSISTED LIVING		FACILITY NUMBER:	306006146
ADMINISTRATOR:	ROCHE, RYAN		FACILITY TYPE:	740
ADDRESS:	18851 FLORIDA STREET		TELEPHONE:	(714) 847-3999
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92648
CAPACITY:	84	CENSUS: 41	DATE:	06/19/2023
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Administrator Taylor Clark		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff spoke to resident in an inappropriate manner
Staff did not provide resident with assistance
Staff did not distribute resident's medications as prescribed

INVESTIGATION FINDINGS:

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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 obtained records and interviews with Sea Cliff Assisted living staff & residents.

On 2/13/23 the department received allegations that facility staff spoke to resident in an inappropriate manner, staff did not provide resident with assistance and staff did not distribute resident’s medications as prescribed. The investigation was completed by the department and revealed the following:
Based off interviews and statements with staff, Three out of eight staff indicated that Staff member 1 (S1) has acted inappropriately at a resident as evidence of verbal altercation. One out of eight staff indicated that they have never witnessed for themselves but has heard complaints regarding Staff 1’s rude behavior. Facility conducted an internal investigation and facilities investigation revealed that on Sunday February 12, 2023 at approximately 9:30PM staff on the first floor heard a loud noise above upstairs. Per written
CONTNUED ON 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023

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-20230213095348

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: 06/19/2023

NARRATIVE

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statements provided to the Administrator, staff 1 & staff 2 went to second floor to Resident 1’s (R1) room and both staff claim that R1 sustained an unwitnessed fall after having a few alcoholic drinks. Both staff members claim visually observing R1 on floor of room with shattered pieces of a marble table. Staff members also claim that there were several alcoholic bottles on R1’s floor as well. According to staff interviews and written statements provided S1 and S2 notified R1 that they needed to call 911 emergency personnel due to R1’s size and could not help lift R1. Staff interviews claim that R1 became agitated with S1 and a verbal altercation between R1 and S1 occurred. Staff 1 denies a verbal altercation occurred as observed from written statement by S1. S2 stated that a verbal altercation was exchanged but did not provide additional information as to what was said between parties. During facilities pending internal investigation Administration took immediate action and suspended S1. Facility contacted Ombudsman and self reported to Licensing agency providing a SOC 341 Report of suspected dependent adult/elder abuse and LIC 624 Unusual Incident Injury Report both dated 2/12/23. As a corrective measure facility provided a 1:1 in service training to S1 regarding abuse prevention prior to S1 returning to work. Investigation also revealed that facility completed a in service training with staff regarding abuse prevention and reporting. According to Administrator Taylor Clark all staff were encouraged to assist R1 in teams of two. Staff interviews revealed that local police were called regarding altercation and police department did not come to facility due to altercation not being physical. Eight out of eight staff members interviewed stated they have never acted inappropriately towards residents verbally or physically. Resident interviews revealed that Five out of Seven residents claim they have never witnessed staff acting or speaking inappropriately in their time at facility. Two of Seven Residents claim that staff have acted inappropriately towards them.

Regarding Allegation Staff did not provide assistance, investigation revealed the following:

Eight out of eight staff members interviewed indicated that they all help assist residents when needed. Caregivers interviewed mentioned that if they are assisting other residents at the time of being paged they communicate via walkie radios if other staff member can help assist resident. Staff try to provide care in a timely manner according to interviews. Staff interviews also revealed that staff conduct wellness checks on residents every two hours. Resident interviews revealed that Three out of Seven Residents interviewed state that facility staff assist residents in a timely manner and two out of seven state staff are delayed in requiring assistance. Resident interviews also revealed that two other residents each claim that two different staff members do not provide assistance when asked upon. One resident claims that staff 1 has be raided and refused assistance. CONTINUED ON 9099C

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20230213095348

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: 06/19/2023

NARRATIVE

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. Resident 2 claims that staff 2 does not help assist resident when asked, however Resident 1 claims that Staff 2 assists them when asked. Both Residents state that all other staff do a great job of assisting and have no issues with others.

Regarding Allegation Staff did not distribute medications as prescribed, investigation revealed the following:

All staff interviewed confirmed that Med Technicians administer meds to residents during meal times in the facility dining room. If a resident is not present during meal times, Med Techs will bring residents their meds to their room. Staff interviews also revealed that if residents inform staff about medication issues, staff contact Med Technician’s regarding resident’s concerns. Two staff revealed that R1 has stated concerns of receiving medications in a timely manner and often requests meds immediately. Staff have informed R1 that Med Tech’s are assisting all residents and try their best to give meds in proper time frame. Staff interviews have stated that meds are being distributed within the hour of med rounds. Two Staff have indicated that R1 has refused meds at times and is notated on Medication Administration Record (MAR). Residents interviewed revealed that Four out of Seven Residents do not and have not had any issues with receiving their medications. One out of Seven Residents states they do not receive meds in timely manner and Two out of seven did not divulge information regarding medications. During LPAs visits LPA reviewed three residents MARs and noted no concerns.

This department has investigated these allegations and based on LPA’s observations, and interviews which were conducted investigation revealed conflicting reports. Although the allegations may have happened or is valid, there is no preponderance of evidence to prove the alleged violations did or did not occur as reported, therefore the allegations are all deemed UNSUBSTANTIATED.

An exit interview was conducted with Administrator and a copy of report and appeal rights along with LIC 811 Confidential Names List was provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023

LIC9099 (FAS) - (06/04)

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