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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006146
Report Date: 07/18/2025
Date Signed: 07/18/2025 11:36:51 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/11/2025 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20250711132039
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: 67DATE:
07/18/2025
UNANNOUNCEDTIME BEGAN:
07:50 AM
MET WITH:Nisha Koirala and Taylor ClarkTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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9
Resident's window is broken
Resident's shirt was soaked in urine
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, LPA toured the facility and interviewed staff, witness and residents. Regarding the allegation that resident's window is broken and resident's shirt was soaked in urine, the investigation revealed the following: LPA observed the window in room 153 is broken and the window sill in room 162 is in need of repair (photos). LPA interviewed witness and staff regarding incontinence care. One out of one witness and three out of four staff confirm incontinence care is not always provided timely and residents sit unchanged for periods of time. Staff confirm instances of resident's clothing being soiled while waiting for incontinence care. Wellness Director indicated instances of staff being terminated for not providing proper incontinence care. Facility staff indicate incontinence care expectations of every two hours but facility does not maintain documentation of when incontinence care is provided.
CONTINUED ON LIC 9099C DATED 07/18/2025
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
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 4
Control Number 22-AS-20250711132039
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: SEA CLIFF ASSISTED LIVING
FACILITY NUMBER: 306006146
VISIT DATE: 07/18/2025
NARRATIVE
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Based on interviews conducted and observation, the preponderance of evidence standard has been met. Therefore the above allegations are found to be SUBSTANTIATED, California Code of Regulations, (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report was provided to facility administrator along with appeal rights.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 22-AS-20250711132039
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SEA CLIFF ASSISTED LIVING
FACILITY NUMBER: 306006146
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/19/2025
Section Cited
CCR
87464(f)(1)
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Basic services shall at a minimum include:
Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code
section 1569.2(c). This req is not met as evidenced by:
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Licensee to provide an in-service on incontinence care and forward proof to LPA by POC due date.
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Based on interviews conducted, Licensee failed to ensure incontinence care is being provided to residents. This poses an immediate health and safety risk to residents in care.
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Type B
08/01/2025
Section Cited
CCR
87303(a)
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The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This req is not met as evidenced by:
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Licensee to repair/ replace noted windows and forward proof to LPA by PC due date.
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Based on observation, Licensee failed to ensure facility is in good repair. LPA observed two windows in need of repair. This poses a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/11/2025 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20250711132039

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: 67DATE:
07/18/2025
UNANNOUNCEDTIME BEGAN:
07:50 AM
MET WITH:Nisha Koirala and Taylor ClarkTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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9
Facility is understaffed.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, LPA toured the facility and interviewed staff and residents as well as reviewed and obtained pertinent documentation such as staff schedule. Regarding the allegation that facility is understaffed, the investigation revealed the following: LPA reviewed staff schedule indicating three caregivers and a med tech for 1st and 2nd shift and one caregiver/ med tech for NOC shift. LPA observed three caregivers, one med tech and Wellness Director during the visit. Four out of four residents and four out of four staff state staffing levels are good and care is being provided. Wellness Director indicates filling call outs with overtime or agency as needed. Four out of four residents state needs are being met at the facility. Based on interviews and observation, the allegation is found to be Unsubstantiated, meaning that although the allegation mentioned above may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred.
An exit interview was conducted and a copy of this report was provided to a facility representative.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4