SEA CLIFF ASSISTED LIVING

Official classification

Type A

Official code

1569.2(c)

Regulation authority

HSC

What the official deficiency says

Health and Safety Code 1569.2(c) provides: " Care and supervision " means the facility assumes responsibility for (...) ongoing assistance with activities of daily living. Assistance includes assistance with personal care. This requirement is not met as evidenced by: Based on observation (...) of photographs, interviews conducted and records reviewed, it was assumed that the home health services included services not included in R1's plan of care. This constitutes an immediate risk to the health, safety and personal rights of residents in care.

Official plan of correction

Licensee will conduct an in-service training in order to ensure facility staff has adequate knowledge of the content of hospice and home health plans of care for residents receiving services from such third parties.

Deadline recorded: Dec 13, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)(2)

Regulation authority

CCR

What the official deficiency says

Per CCR87307(a)(2) on Personal accomodations: " Bedrooms shall be large enough to allow for easy passage between and comfortable usage of beds and other required items of furniture specified below, and any resident assistant devices such as wheelchairs or walkers " . This requirement is not met as evidenced by: Based on observation, the partitioned half of R1's unit did not allow easy passage via wheelchair on the sides of the bed. This constitute a potential risk to the health, safety and personal rights of individuals in care.

Official plan of correction

R1 was moved back to their original unit after an outbreak concluded. Unit verified to be providing sufficient space for a wheelchair. Deficiency cleared.\

Deadline recorded: Dec 13, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87204(a)

Regulation authority

CCR

What the official deficiency says

(a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. An exception may be made in the case of catastrophic emergency when the licensing agency may make temporary exceptions to the approved capacity. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above. R1 is non-ambulatory per physician report and is residing on the second floor. Facility license indicates non-ambulatory residents must be on the first floor. This poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/06/2025 Plan of Correction Licensee to relocate R1 and forward proof to LPA by POC due date.

Official classification

Type A

Official code

1569.17(c)(1)(A)

Regulation authority

HSC

What the official deficiency says

(c)(1)(A) Subsequent to initial licensure, a person specified in subdivision (b) who is not exempted from fingerprinting shall obtain either a criminal record clearance or an exemption, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in a facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in two staff who are not criminally cleared and associated to the facility which poses an immediate health, safety or personal rights risk to persons in care. CIVIL PENALTY ASSESSED.

Official plan of correction

POC Due Date: 08/06/2025 Plan of Correction Licensee to obtain criminal record clearance and forward proof to LPA by POC dye date.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(a) 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 requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPAs observed discoloration on walls and doors as well as a sink backing up which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/19/2025 Plan of Correction Licensee to repair noted items and forward proof to LPA by POC due date.

Official classification

Type B

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

(c) All window screens shall be clean and maintained in good repair. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPAs observed sliding door screen in the dining room is in need of repair which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/19/2025 Plan of Correction Licensee to repair/ replace screen and forward proof to LPA by POC due date.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in three out of six staff who do not have required training. Staff #2,3 and 6 do not have required training: 8 hours Dementia and 4 hours of postural supports, hospice and restricted conditions which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/19/2025 Plan of Correction Licensee to provide training and forward proof to LPA by POC due date.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in three out of three residents without physician orders for bed rails which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/19/2025 Plan of Correction Licensee to obtain physician orders for bed rails and forward proof to LPA by POC due date.

Official classification

Type A

Official code

1569.50(a)(3)

Regulation authority

HSC

What the official deficiency says

Conduct that is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above. LPAs were provided falsified health screen documents and staff confirmed the documents had been falsified which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/06/2025 Plan of Correction Licensee to conduct an in-service on appropriate conduct and forward proof to LPA by POC due date.

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

ll facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. Facility does not have a designated back up administrator during today's visit and staff from the skilled nursing are assisting LPAs which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/19/2025 Plan of Correction Licensee to forward an updated LIC 308 to LPA by POC due date.

Official classification

Type B

Official code

87411

Regulation authority

CCR

What the official deficiency says

All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in five out of six without a health screen/ TB which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/19/2025 Plan of Correction Licensee to obtain health screening/ TB assesssment and forward proof to LPA by POC due date.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department..This req is not met Based on record review and interview, Licensee failed to ensure S1 has a criminal background check. This poses an immediate health and safety risk to residents in care. CIVIL PENALTY ASSESSED

Official plan of correction

Licensee took S1 to get a clearance during the visit. License to forward clearance to LPA.

Deadline recorded: Jul 19, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

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: 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.

Official plan of correction

Licensee to provide an in-service on incontinence care and forward proof to LPA by POC due date.

Deadline recorded: Jul 19, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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: 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.

Official plan of correction

Licensee to repair/ replace noted windows and forward proof to LPA by PC due date.

Deadline recorded: Aug 1, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87629(a)(b)(1)

Regulation authority

CCR

What the official deficiency says

87629(a)(b)(1)- (a) The licensee shall be permitted to accept or retain a resident who requires intramuscular, subcutaneous, or intradermal injections if the injections are administered by the resident or by an appropriately skilled professional. Ensuring that injections are administered by an appropriately skilled professional should the resident require assistance. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section. LPA identified resident #7 & #8 were administered diabetic insulins injections by a non- appropriately skilled professional staff daily. This violation which poses an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/09/2024 Plan of Correction Licensee will ensure will review regulation 87629 regarding the appropriate skilled professional to administer injections. The adminstrator will submit documentation and has read the regulation and how to comply moving forward. Proof of correction will be sent to LPA by email: ernand.dabuet@dabuet@dss.ca.gov by POC date.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing, or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above. LPA identified staff #1-#5 (S1-S5) not have criminal record clearance transfer. Staff did not have an LIC 9162 on file nor transferred on CDSS Guardian. This violation which poses an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/09/2024 Plan of Correction Licensee will ensure all staff have criminal clearance transfer prior to working at the facility. Staff #1-#5 (S1-S5) according to CDSS Guardian is not associated to this facility. Licensee will associate staff #1-#5 (S1-S5)by POC due date. Send proof of correction by email to ernand.dabuet@dss.ca.gov

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA observed (1) cleaning solution " clorox bleach and (2) sharp scissors in resident rooms accessible to residents in care. This violation which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/08/2024 Plan of Correction Licensee will ensure to adhere to Title 22 87309 (a) and ensure all toxic and hazardous items are kept in a locked storage compartment and not accessible to residents in care. Proof of correction must be sent to LPA at ernand.dabuet@dss.ca.gov. ***Corrected during visit 12/7/24***

Official classification

Type B

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or nonambulatory residents, based on the residents' needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA identified bathroom cabinet sink with a missing/brokern door in resident's room #164. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/21/2024 Plan of Correction Licensee will ensure to adhere to Title 22 87303 Regulations and to ensure all bathing facilities shall maintained in operating condition. Licensee agreed to have the sink cabinet door/replaced or repaired by POC date. Proof of correction must be sent to LPA at ernand.dabuet@dss.ca.gov

Official classification

Type B

Official code

80075(f)

Regulation authority

CCR

What the official deficiency says

(f) Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above. Staff #2 -#5 did not have First Aid/CPR certificate on file. This violation which poses a potential health, safety, or personal rights risk to persons in care

Official plan of correction

POC Due Date: 12/21/2024 Plan of Correction Licensee will ensure all facility staff must have the mandatory First Aid/CPR Training completed. As plan of correction, administrator will send proof of completed First Aid/CPR will be sent to LPA via email: ernand.dabuet@dss.ca.gov before POC due date.