306006146-3-18-2024-22-AS-AJLO-D3LTK3-20240322144716

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006146
Report Date: 03/18/2024
Date Signed: 03/18/2024 03:51:41 PM

Unsubstantiated

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
03/11/2024 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240311130718

FACILITY NAME:	SEA CLIFF ASSISTED LIVING		FACILITY NUMBER:	306006146
ADMINISTRATOR:	CLARK, TAYLOR		FACILITY TYPE:	740
ADDRESS:	18851 FLORIDA STREET		TELEPHONE:	(714) 847-3999
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92648
CAPACITY:	84	CENSUS: 52	DATE:	03/18/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Taylor Clark		TIME COMPLETED:	04:05 PM

ALLEGATION(S):

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Facility staff failed to meet residents’ needs.

INVESTIGATION FINDINGS:

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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegation. LPA met with Administrator (AD) Taylor Clark and explained the reason for today’s inspection.

The investigation into the allegation that the facility staff failed to meet residents’ needs revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, staff, and residents, and obtained and reviewed copies of the resident roster, staff roster, Resident #1’s (R1) Resident Appraisal dated 10/04/23, R1’s Needs and Services Plan dated 10/04/23, R1’s Physician’s Report dated 05/02/23, the facility’s Caregiver Resident Assignments, and the facility’s Incontinence Care Logs for 03/09/24.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

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-20240311130718

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: 03/18/2024

NARRATIVE

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Regarding the allegation that the facility staff failed to meet residents’ needs: it was alleged that on 03/09/24, R1 was observed soiled, staff would not change R1 on the basis that R1 refuses changes, and R1 has been observed to be soiled on multiple occasions. LPA interviewed AD who reported that R1 does receive incontinence care at the facility and that incontinence care provided is documented, but that the staff do not always properly document when incontinence care was provided. LPA reviewed R1’s Resident Appraisal dated 10/04/23, R1’s Needs and Services Plan dated 10/04/23, and R1’s Physician’s Report dated 05/02/23 which state that R1 needs assistance with incontinence care. LPA reviewed the facility’s Caregiver Resident Assignments which shows that R1 should be checked on by staff three times per shift to see if R1 needs incontinence care. However, the facility’s Incontinence Care Logs for 03/09/24 do not indicate R1 received incontinence care on that day. LPA interviewed nine residents, none of whom corroborated the allegation. LPA conducted health and safety checks on the nine residents, observed no health and safety issues, and observed the residents to be clean and in good spirits. LPA inspected the nine resident’s rooms and observed the rooms to be clean and free from odor. LPA observed the facility has a sufficient supply of incontinence supplies. LPA interviewed four staff who reported that although R1 does need incontinence care, R1 is able to change their own diapers and will sometimes refuse help from staff. The staff stated that R1 is generally able to change their own diapers, but that they also make sure R1 properly changed their diaper if R1 refused help and chose to change it themselves. LPA’s interview with R1 corroborated the staff’s statements and R1 reported no issues regarding incontinence care at the facility.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

LIC9099 (FAS) - (06/04)

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