306006146-9-28-2026-22-AS-TSIY-DYCVU7-20260928164417

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006146
Report Date: 09/28/2026
Date Signed: 09/28/2026 04:44:59 PM

Document Has Been Signed on 09/28/2026 04:44 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 LIVING		FACILITY NUMBER:	306006146
ADMINISTRATOR/ DIRECTOR:	CLARK, TAYLOR		FACILITY TYPE:	740
ADDRESS:	18851 FLORIDA STREET		TELEPHONE:	(714) 847-3999
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92648
CAPACITY: 84		CENSUS: 64	DATE:	09/28/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:20 AM
MET WITH:	Taylor Clark, Administrator		TIME VISIT/ INSPECTION COMPLETED:	05:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Taylor Simerly made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by staff. During today’s visit, LPA met with Taylor Clark, Administrator. The Administrator has a valid administrator certificate through March 8, 2027. The facility is licensed for 84 residents of which 44 may be non-ambulatory (first floor). Facility has an approved hospice waiver for 20 residents. The facility currently has a census of sixty-four in care and two on hospice. The facility is a two story building consisting of resident bedrooms, an activities room, library, kitchen and outdoor space. The facility is connected to a skilled nursing facility. The facility shares a kitchen with the skilled nursing facility and food is brought over on warming trays to a smaller kitchen for the assisted living community. LPA observed the PUB 475 “See Something Say Something” poster posted in the entryway. During today’s visit, LPA, administrator and maintenance director toured the facility and inspected the physical plant. The hot water temperature measured between 113.7 to 114.5 degrees F. LPA noted bathroom toilets were in working order and grab bars and non-skid floor mats were provided. Hygiene supplies, including towels and toiletries, were adequately stocked. The facility was observed to be clean, safe, and well maintained. Client bedrooms were appropriately furnished with beds, linens, and sufficient storage space. Smoke detectors and carbon monoxide detectors are tested monthly in-house. Fire inspections are conducted by an outside company, Complete Fire Service Inc., with the last inspection date of January 8, 2026. Fire extinguishers are fully charged and operable. Continued on the LIC 809C

Alfonso Iniguez
Taylor Simerly
	DATE: 09/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: 09/28/2026

NARRATIVE

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LPA toured the exterior and observed a shaded seating area for client use, no hazards or obstacles were observed. The facility has three outdoor patio areas for resident use.

LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. Sharp items and knives were located in the kitchen and were locked and inaccessible to residents. Facility had back-up emergency food and water supply located on both the first and second floors. Cleaning supplies were locked and stored away from food.

Medication storage and administration practices were reviewed. Medications were securely stored in a locked cabinet and administered in accordance with physician order. LPA reviewed the centrally stored medications for multiple clients and no discrepancies observed. The First Aid Kit had the required elements.

LPA reviewed ten staff files and ten client files. No discrepancies were noted in the staff or client files.

LPA conducted interviews with staff and clients regarding the quality of care and services provided.

Based on observations and record reviews conducted during today’s inspection, no deficiencies were cited in the areas evaluated in accordance with Title 22, Division 8 of the California Code of Regulations. An exit interview was conducted with Taylor Clark, Administrator and a copy of this report was given to the facility along with a copy of the LIC 858 and LIC 859.

NAME OF LICENSING PROGRAM MANAGER: Alfonso Iniguez
NAME OF LICENSING PROGRAM ANALYST: Taylor Simerly
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2026

LIC809 (FAS) - (06/04)

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