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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006146
Report Date: 09/12/2026
Date Signed: 09/12/2026 12:43:39 PM

Unfounded


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
06/18/2025 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20250618134727
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: 60DATE:
09/12/2026
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Nisha KoiralaTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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9
Facility failed to report death to Licensing Agency
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to finalize an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. An initial investigation visit was conducted on June 19, 2025 and a subsequent was conducted on July 17, 2025 by the Department.
It was alleged facility failed to report death to Licensing Agency. During the investigation, the Department reviewed records obtained.
The investigation determined as follows: Regarding the allegation facility failed to report death to Licensing Agency, it was reported Resident 1 (R1)’s death was not reported to the Department. Record review revealed the facility faxed a copy of R1’s death report to the Department on June 9, 2026 at 4:47pm. The facility provided a copy of the death report along with the fax receipt indicating the fax was sent successfully to the Department.
CONTINUED ON LIC 9099C DATED 09/12/2026
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2026
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-20250618134727
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: 09/12/2026
NARRATIVE
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Based on record review, LPA is unable to corroborate the allegations. Therefore, the allegation is deemed to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.
An exit interview was conducted and a copy of the report was left with the facility representative.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2026
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
06/18/2025 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20250618134727

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: 60DATE:
09/12/2026
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Nisha KoiralaTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not ensure that a resident's durable medical equipment was adequately functioning, resulting in death.
A chair in a facility resident's unit was mildewed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to finalize an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. An initial investigation visit was conducted on June 19, 2025 and a subsequent was conducted on July 17, 2025 by the Department.

It was alleged facility staff did not ensure that a resident’s durable medical equipment was adequately functioning, resulting in death and a chair in a facility resident’s unit was mildewed. During the investigation, the Department conducted interviews with staff and a resident in care. The Department reviewed records obtained. The investigation determined as follows: Regarding the allegation staff did not ensure that a resident’s durable medical equipment was adequately functioning, resulting in death, it was reported Resident 1 (R1)’s oxygen concentrator was malfunctioning and not providing oxygen to the resident, leading to R1’s death. Interview with Resident 2 (R2) stated they were R1’s roommate. R2 added CONTINUED ON LIC 9099C DATED 09/12/2026
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 22-AS-20250618134727
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: 09/12/2026
NARRATIVE
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R1 suffered from a seizure one evening and was taken to the hospital by paramedics. R2 did not see R1 after that. Interviews with two out of five staff stated R1 would use the oxygen concentrator but would remove the nasal cannula sometimes because it would make R1 uncomfortable. One out of those two staff added R1was on home health and it was up to home health to check the oxygen concentrator provided by them. One out of the remaining three staff stated R2 told them R1 would regularly remove their nasal cannula and not use it. The staff member added they were present on the evening of June 4, 2025 when R1 experienced a medical emergency, paramedics were called and CPR was performed while the paramedics came. R1 was stabilized at the facility before being transported to the hospital. One of the remaining two staff stated they would call a med tech whenever R1 would ask for oxygen to assist. The remaining staff stated R1 was on dialysis for some time before they passed away. The staff member added R1 was taken off dialysis treatments by their physician. Record review revealed R1 was diagnosed with end-stage renal disease based on hospital report dated June 4, 2025. The report concluded R1 suffered “Cardiac arrest likely secondary to hyperkalemia and hypoglycemia. R1’s physician’s orders dated March 27, 2025 indicated “Oxygen 2-4 LPM PRN via nasal cannula to keep SpO2 greater than 90% every 24 hours as needed.” R1 death certificate dated June 6, 2025 indicates R1 passed from cardiac arrest.
Regarding the allegation a chair in a facility resident’s unit was mildewed, it was reported Resident 3 (R3)’s room had a chair with mildew. The Department entered R3’s room on June 19, 2025 and did not observe mildew on the chair or any mildew odors in the room.

Based on interviews, record review, and observations, the allegations facility staff did not ensure that a resident’s durable medical equipment was adequately functioning, resulting in death and a chair in a facility resident’s unit was mildewed were therefore deemed unsubstantiated meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted and a copy of the report was left with the facility representative.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4