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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006146
Report Date: 11/07/2023
Date Signed: 11/07/2023 04:11:12 PM


Document Has Been Signed on 11/07/2023 04:11 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 COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



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: 45DATE:
11/07/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:36 PM
MET WITH:Administrator, Taylor ClarkTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Jenifer Tirre is conducting this Case Management Visit for the purpose of conducting a Health and Safety Check to follow up on a self reported incident received on 11/7/2023 regarding Personal Rights Violation of Resident 1(R1). LPA was greeted and granted entry by staff. This visit is being conducted for the purpose of reviewing and collecting facility records. LPA discussed the purpose of the visit with Administrator Taylor Clark.

During the inspection LPA toured the facility, conducted interviews, completed a review of Resident’s records, completed a review of staff records, and obtained copies of pertinent documents. LPA observed Residents to be relaxing in common areas and inside bedrooms. LPA observed residents to be well groomed with no visible injuries noted. Residents in care appeared to be safe, no imminent health and safety hazards were observed during visit.

Based on the observations made during today’s visit, no deficiencies were cited. LPA conducted an exit interview with Administrator and provided a copy of this report to the facility.

SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2023
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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