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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006146
Report Date: 03/06/2024
Date Signed: 03/06/2024 10:20:20 AM


Document Has Been Signed on 03/06/2024 10:20 AM - 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: DATE:
03/06/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Administrator, Taylor ClarkTIME COMPLETED:
10:50 AM
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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit to deliver findings on an investigation completed by the Department. LPA was greeted and granted entry into the facility by staff. LPA met with Administrator Taylor Clark and explained the reason for the visit.

On November 7, 2023, the Department received a self reported incident of possible sexual abuse. The purpose of today’s visit is to follow up on an investigation conducted by the Department regarding the above allegation. The investigation conducted revealed the following:

Resident 1 (R1) was admitted to the facility on January 19, 2023. Per Physician report dated April 15, 2023, R1 has a diagnosis of Mild Cognitive Impairment and is able to communicate needs.

On November 04, 2023, at approximately 1 PM, R1 reported Staff 1 (S1) entered their room unannounced during which time they found R1 crying on their bed, upset. Upon finding R1 upset, S1 asked R1 if they would like a hug. R1 reported stating yes; however, R1 later reported while hugging them, S1 slid their arm around and began touching R1’s chest and slid a hand underneath R1’s pajamas touching their genital area. R1 stated they attempted to push S1 away which startled them. R1 asked S1 for a large trash bag for their room which caused S1 to get up and retrieve the bag as requested before leaving.

R1 reported the incident to caregivers who reported it to Administrator Taylor Clark the following day. The Local Police Department was notified of the incident and a written report submitted to the Department reporting the incident. When interviewed, S1 admitted to giving R1 a hug but denied touching R1 in any inappropriate way. S1’s employment was terminated from the facility on November 10, 2023, due to previous counseling/disciplinary notices in addition to the above mentioned incident.

CONTINUED ON 809C

SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 03/06/2024
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Interviews with two of three residents described S1 as friendly and reported they had never been inappropriately touched by a staff member.

Therefore, based on interviews conducted and documents reviewed, the allegation is deemed unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted, and a copy of this report and confidential names list was left at the facility.

SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
LIC809 (FAS) - (06/04)
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