Sea Cliff Assisted Living

Type of visit: Required - 1 Year

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 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.the state’s words, verbatim · CDSS document, Sep 28, 2026

Allegation investigated: Facility failed to report death to Licensing Agency

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 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. 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.the state’s words, verbatim · CDSS document, Sep 12, 2026 · control 22-AS-20250618134727

Allegation investigated: Neglect/lack of supervision resulted in resident developing a stage three pressure injury.

On June 16, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived at the facility unannounced for a subsequent complaint investigation visit into the above allegation. The Administrator Taylor Clark and Wellness Director Parinaz Safari were present and assisted with the investigation. LPA reviewed facility documents including: Resident Roster, Staff Roster, Staff Schedule, Staff Contacts, and six resident files. Interviews were conducted with a witness and staff. Based on a facility record review and interview with Administrator, the investigation revealed that Resident (R1) is a resident at Sea Cliff Healthcare Center Skilled Nursing and not Sea Cliff Assisted Living. Sea Cliff Healthcare Skilled Nursing is an entity of California Department of Public Health. This agency has investigated the complaint alleging neglect/lack of supervision resulted in resident developing a stage three pressure injury. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without reasonable basis. An exit interview was conducted with Administrator Taylor Clark and a copy of report was provided to facility. Unfoundedthe state’s words, verbatim · CDSS document, Jun 16, 2026 · control 22-AS-20260601085030

Allegation investigated: Resident sustained rash due to staff neglect. Staff mishandled residents medication. Resident fell out of bed and chair due to staff neglect. Staff do not ensure resident's hygiene needs are being met.

On June 16, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived at the facility unannounced for an initial complaint investigation visit into the above allegations. The Administrator Taylor Clark and Wellness Director Parinaz Safari were present and assisted with the investigation. LPA reviewed facility documents including: Resident Roster, Staff Roster, Staff Schedule, Staff Contacts, and six resident files. Interviews were conducted with a witness and staff. Based on a facility record review and interview with Administrator, the investigation revealed that Resident (R1) is a resident at Sea Cliff Healthcare Center Skilled Nursing not Sea Cliff Assisted Living. Sea Cliff Healthcare Skilled Nursing is an entity of California Department of Public Health. This agency has investigated the complaint alleging the above allegation. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without reasonable basis. An exit interview was conducted with Administrator Taylor Clark and a copy of report was provided to facility. An exit interview was conducted with Administrator Taylor Clark and a copy of this report was provided at the end of the visit. Unfoundedthe state’s words, verbatim · CDSS document, Jun 16, 2026 · control 22-AS-20260609112020

Allegation investigated: Lack of care and supervision Resident not treated with dignity and respect

Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to conclude investigation into the above identified complaint allegations. LPA spoke with Taylor Clark, Administrator, and explained the purpose of the visit. Findings are based upon this investigation which included tour of the facility, facility file review, resident file review, interviews conducted, and copies of pertinent records. It is alleged there is lack of care and supervision, specifically to leaving resident (R1) soiled and adjusting R1’s bed at mealtime. Record review revealed that physicians report states resident is able to feed self, able to do own toileting with minimal assistance, and able to independently transfer to and from bed. Service plan reflects resident meal tray as requested, toileting incontinence care will be maintaining the Continued on LIC9099-C Unsubstantiated highest practicable level of independence when toileting, transfer self independently, offer reminder to call for assistance when transferring. Interview with 4 of 4 staff stated R1 always gets changed and not left soiled, and when resident ask for tray services staff adjust R1 in bed for mealtime. R1 gets changed often and does not get left soiled for extended periods. Interview with 6 of 6 residents stated that they get the help they need from staff, have seen staff help R1, see staff providing help to R1 with meal trays, and staff always come to help them when they call for help. It is alleged that R1 is not treated with dignity and respect, specifically to R1 being treated roughly, unable to communicate with staff, and often being ignored by staff. Records review reflect resident appraisal states R1 diagnosed with depression, a little sign of confusion and forgetfulness, cognitive communication deficits, and not interested in socializing. Service plan reflects occasional forgetfulness with reminders, reminders to person, place, time, task, or personal hygiene. Interview with 6 of 6 residents stated staff treat them well, they have no issues to report. Residents can communicate with staff with no problem, do not wait a long time for help, and they are not rough with them. Residents state they have not see staff be rough with any residents. Interview with R1’s roommate stated that they have seen staff assist R1 with their needs, see staff able to communicate with R1. They have seen staff help R1 with feeding, changing them, and come to help when R1 calls for help. Based on the information mentioned above, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, the allegations are deemed Unsubstantiated. An exit interview was conducted with the Administrator and a copy of this LIC9099 report was left at facility.the state’s words, verbatim · CDSS document, May 12, 2026 · control 22-AS-20250619132018

Allegation investigated: Resident was exposed to scabies while in care.

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility to deliver findings regarding the above-referenced allegation. Upon arrival, LPA Haddadin was greeted and granted entry by Parinaz Safari, Wellness Director. The investigation included interviews with six staff members and six residents, a review of facility records, and observations of the physical plant. It was alleged that “Resident was exposed to scabies while in care.” During record review, LPA Haddadin confirmed that on October 17, 2025, the facility notified Community Care Licensing and submitted an incident report documenting that one resident (R1) tested positive for scabies. The records reviewed did not identify any additional residents with a confirmed scabies diagnosis and did not indicate a scabies outbreak at the facility. LPA Haddadin interviewed six residents regarding whether they were notified of scabies exposure, experienced symptoms consistent with scabies, or had concerns about an outbreak. {***CONTINUE9099C***} Unsubstantiated Five of the six residents denied being exposed to scabies while in care, denied receiving any notice of scabies exposure, and denied experiencing symptoms consistent with scabies during their residency. One resident reported having scabies while in care related to the October 17, 2025 incident. This resident stated the facility immediately isolated the affected resident and facilitated medical attention, and the resident did not believe other residents were placed at risk. LPA Haddadin interviewed six staff members regarding whether any residents other than R1 were suspected or confirmed to have scabies, whether any exposure occurred within the facility, and whether an outbreak occurred. All six staff members denied that residents were exposed to scabies while in care and stated they were not aware of any additional confirmed cases beyond R1. LPA Haddadin conducted a walk-through of the facility and observed common areas and resident living spaces. At the time of the visit, LPA Haddadin did not observe conditions consistent with a facility-wide scabies exposure event, such as residents being placed on isolation precautions, resident complaints of rash or persistent itching, or an increased use of personal protective equipment (PPE) that would suggest an outbreak. Information obtained through interviews and record review did not support that residents other than R1 had a confirmed scabies diagnosis, received scabies treatment, or were placed on contact precautions due to exposure. Based on the evidence obtained during the investigation, the allegation is found to be Unsubstantiated, meaning that although the allegation may have occurred or may be valid, there is not a preponderance of evidence to substantiate that the alleged violation occurred. An exit interview was conducted, and a copy of this report was provided to a facility representative.the state’s words, verbatim · CDSS document, Feb 15, 2026 · control 22-AS-20251023144519

Allegation investigated: Facility staff failed to report scabies outbreak.

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility to deliver findings to the above-referenced allegation. Upon arrival, LPA Haddadin was greeted and granted entry by Administrator Taylor Clark (AD). The investigation included interviews with six staff members and six residents, a review of facility records, and observations of the physical plant. It was alleged that “Facility staff failed to report scabies outbreak”. LPA Haddadin reviewed facility records and confirmed that, on October 17, the facility’s Wellness Director notified Community Care Licensing and submitted an incident report regarding one resident (R1) who tested positive for scabies. LPA Haddadin interviewed six residents, and six of six denied that the facility experienced an outbreak or failed to report. LPA Haddadin also interviewed six staff members, and all six denied the allegation. {***CONTINUE9099C***} Unfounded During record review of R1’s file, LPA Haddadin confirmed the facility updated documentation to reflect the change in condition by updating the LIC 603 (Resident Appraisal). LPA Haddadin also conducted a walk-through of the facility and did not observe any indications consistent with an outbreak, including visible signs of illness or an increased presence of PPE (Personal Protective Equipment). Based on the preponderance of evidence obtained through record review, interviews, and observations, the allegation is determined to be UNFOUNDED, meaning the allegation is false, could not have happened, and/or is without a reasonable basis. No deficiencies were cited during today’s visit. An exit interview was conducted with the Administrator, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 15, 2026 · control 22-AS-20251023144519

Allegation investigated: Staff does not ensure resident is provided a comfortable living space. Staff does not ensure resident's health needs are being met

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on the investigation of the allegations listed above. LPA was greeted and granted entry by facility staff after introducing himself and stating the purpose of the visit. Administrator Taylor Clark was present on the premises and assisted with the visit. An initial investigation visit was conducted on September 29, 2025. LPA requested and obtained records for six current residents. LPA accompanied by licensing staff completed a tour of the facility's first level and reviewed multiple shared and private units. LPA conducted three resident interviews and one staff interview during the visit. After the visit, facility staff provided LPA with the facility's current plan of operations, dementia care plan, visitor check-in log, resident daily sign-out sheet, charting notes for resident R1 for the month of September 2025, assistance log for R1, incontinence log for R1. Home health plan of care and admission assessments were also obtained directly from the provider. CONTINUED ON FORM LIC9099-C Substantiated CONTINUED FROM FORM LIC9099-A During the present visit, LPA requested the facility's resident census and toured the physical plant again. Additional resident records were requested and reviewed. Regarding the allegation that Staff does not ensure resident's diapering needs are being met, the following has been concluded: Based on assistance logs and incontinence logs provided, regular checks and diaper changes were being performed and documented during each shift in order to manage R1's assessed incontinence. Resident interviews failed to evidence any failure to address incontinence issues in a timely manner. Regarding the allegation that Staff does not ensure resident is provided clean clothing, the following has been concluded: During the initial investigation visit, LPA observed R1 relaxing in bed dressed in clothing that appeared to be free of visible stains and odors. Logs provided by facility staff appear to evidence due diligence conducted in order to ensure R1 was not provided with soiled clothing. Regarding the allegation that Staff does not ensure the safety of residents by monitoring entry and egress, the following has been conducted: Per the current plan of operation in place, the facility did not staff a front desk full time. However, facility policies required that visitors systematically sign-in as well as residents sign out prior to exiting the premises. Alert system preventing exits that would not be monitored are stated to be in place. Entry logs and sign-out logs were provided and appear to demonstrate most visitors do indeed abide by the facility's policy. As a result, all three allegations listed above are found to be 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 this report was provided to a facility representative. CONTINUED FROM FORM LIC9099-A During the present visit, LPA requested the facility's resident census and toured the physical plant again. Additional resident records were requested and reviewed. Regarding the allegation that Staff does not ensure residents are provide adequate bedroom lighting, the following has been concluded: During the initial complaint investigation visit, LPA observed ceiling lights in addition to an accessible lamp by the side of R1's bed. Lamp was verified to be in operation. Per resident interview, staff was available to turn the light on if R1 wished to benefit from brighter lighting. As a result, the allegation is determined to be Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of this report was provided to a facility representative. CONTINUED FROM FORM LIC9099 During the present visit, LPA toured the physical plant again. Additional resident records were requested and reviewed. Regarding the allegation that Staff does not ensure resident is provided a comfortable living space, the following has been concluded: Based on observation conducted during the initial investigation visit, it was determined that during a COVID outbreak that occurred at the facility in September 2025, R1 was moved from unit #153 to unit #167 where she was during the initial visit. Unit 167 was assigned to resident R1 along with another resident was divided unevenly between the two residents as multiple storage boxes were placed at the foot of R1's roommate's bed. The partition used did not leave sufficient circulation room on both sides of the bed in order for R1 to transfer safely onto their wheelchair. R1 eventually returned to unit 153B which was set up differently and provided sufficient space until they moved out on November 21, 2025. Regarding the allegation that Staff does not ensure resident's health needs are being met, the following has been concluded: During the investigation, photographs were provided showing that R1's lower extremities were not being attended to and their toe nails were not being trimmed. Staff interviewed stated that it had been assumed that the resident's home health provider was in charge of these health needs, however a review of R1's home health plan of care in place at the time found no indication that this was actually the case. As a result, both allegations are found to be Substantiated, meaning that the preponderance of evidence threshold has been met. See attached form LIC9099-D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Dec 12, 2025 · control 22-AS-20250925212426

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.2(c) · Plan of correction due date: Dec 13, 2025

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.the state’s words, verbatim · CDSS document, Dec 12, 2025

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.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a)(2) · Plan of correction due date: Dec 13, 2025

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.the state’s words, verbatim · CDSS document, Dec 12, 2025

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.\

Allegation investigated: Facility is understaffed.

On October 23, 2025, Licensing Program Analyst (LPA) Edward Kim conducted a subsequent complaint visit to deliver complaint investigation findings. LPA met with Executive Director (ED) Taylor Clark and explained the purpose of today’s visit. The investigation consisted of the following: LPA Kim toured the facility with ED Taylor Clark. LPA Kim requested and obtained copies of the Resident and Staff Rosters, Plan of Operation, Staffing Schedule, Staffing Ratio Record, and other pertinent documentation. LPA conducted interviews with five residents and six staff. The investigation revealed the following: Continued on LIC9099C Unsubstantiated Allegation: Facility is understaffed It is alleged that there are three caregivers in the morning shift, but there needs to be at least four caregivers. Based on interviews conducted, six out of six staff denied the allegation. All staff stated staffing levels are good and sufficient care is being provided. S1 and S2 stated that the 1st shift (AM Shift) and the 2nd Shift (PM Shift) has three caregivers, one medication technician, Wellness Director, and Executive Director available. They also stated the Nocturnal Shift (NOC) has one medication technician and one caregiver. This was corroborated based on record review, where the facility weekly schedule shows three caregivers and one medication technician for the 1st Shift (AM Shift) and 2nd shift (PM Shift), and one caregiver and one medication technician for NOC shift. This was also corroborated based on LPA’s observations on August 28, 2025, LPA Edward Kim observed 3 caregivers and 1 medication technician at the facility with 60 residents present. On October 23, 2025, LPA observed three caregivers, medication technician, Wellness Director, and Executive Director at the facility with 63 residents present. Based on record review The Sea Cliff Assisted Living Staffing Ratio Record which is called Staffing Ladder details a ratio between the census number with the different shifts and the number of staff required in a table chart. On August 28, 2025, the census was at 60 residents and on October 23, 2025, the census was at 63 residents. The Staffing Ladder ratio lists the following per shift for the census at 60-63 residents: morning shift needs 3 caregivers, 1 medication technician, and 2 housekeepers; afternoon shift needs 3 caregivers and 1 medication technician; and night shift needs 1 caregiver and 1 medication technician. This corroborates S1 and S2 interview, Facility weekly schedule, and LPA’s observations. S1 and S2 also stated that if any caregiver calls out that the Executive Director, Wellness Director, and Medication Technician are expected to help provide care for the residents. In addition to that, the facility will call staff and/or an agency to cover unplanned absences. Based on interviews conducted, four residents stated that the facility is understaffed because the facility does not respond in a timely manner whenever a call light is pressed. LPA observed in two resident rooms that when call lights were pressed, the facility staff responded in a timely manner. Based on Information gathered, there is no sufficient evidence to corroborate the above allegation. Continued on LIC9099C Based on records review, interviews, and observations, LPA did not find sufficient evidence to support the above allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. An exit interview was conducted, and a copy of this report was provided to the Executive Director Taylor Clark.the state’s words, verbatim · CDSS document, Oct 23, 2025 · control 22-AS-20250806104200

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit, based upon the deficiencies cited in LIC form 809D on 07/18/2025 and 08/05/2025. LPA was greeted and granted entry into the facility and explained the reason for the visit. *Deficiency cited under Title 22 Regulation 87464(f)(1) pertaining to Basic Services has been cleared. Licensee provided proof of correction. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87303(a) pertaining to Maintenance and Operation has been cleared. Licensee provided proof of correction. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87355(e)(2) pertaining to Background Clearance has been cleared. Licensee provided proof of correction. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87204 pertaining to Limitations- Capacity and Ambulatory Status has been cleared. Resident has been moved to the first floor. Licensee has complied with the terms of the POC. *Deficiency cited under H & S Code 1569.17(c)(1)(A) pertaining to Finger Print Clearance has been cleared. Licensee has provided proof of correction. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87303(c) pertaining to Window Screens has been cleared. Window screen has been repaired. Licensee has complied with the terms of the POC. CONTINUED ON LIC 809C DATED 09/11/2025 *Deficiency cited under Title 22 Regulation 87608(a)(3) pertaining to Postural Supports has been cleared. Licensee provided proof of correction. Licensee has complied with the terms of the POC. *Deficiency cited under H & S Code 1569.625(b)(2) pertaining to Required Training has been cleared. Licensee provided proof of correction. Licensee has complied with the terms of the POC. *Deficiency cited under H & S Code 1569.50(a)(3) pertaining to Conduct Inimical has been cleared. Licensee provided proof of correction. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87405(a) pertaining to Administrator Qualifications has been cleared. Licensee provided proof of correction. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87411 pertaining to Health Screen/ TB has been cleared. Licensee provided proof of correction. Licensee has complied with the terms of the POC. Licensee has been advised to maintain compliance on all items previously cited. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Sep 11, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Kimberly Lyman and Andrea Mendivil conducted an unannounced visit to Sea Cliff Assisted Living. The purpose of today’s visit was to conduct the Annual Required inspection. LPAs were allowed entry into the facility and explained the reason for the visit. Facility is licensed for 84 ambulatory of which 44 may be non-ambulatory (first floor). Facility has an approved hospice waiver for 20 residents and the facility currently has 5 residents on hospice care. Taylor Clark has an administrator certificate expiring on 03/08/2027. Assistant Administrator for the skilled nursing side Jaleesa Chavez arrived during the visit. LPAs Lyman and Mendivil along with Assistant Administrator Chavez toured the facility at 9:18 AM. LPAs toured the physical plant, checked food service, facility records and the first aid kit. Facility consists of one main building housing assisted living residents. LPAs observed kitchen, dining room, library and outside patios. Resident rooms had the required furnishings in rooms. At approximately 9:40 AM, LPAs observed discoloration on walls and door in room 154. LPAs observed discoloration on wall in room 221 and sink is backing up in room 210. Resident restrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 108 and 111 degrees F in facility restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Staff responded within 8 minutes for emergency cord pull. Common areas were clean and clear of hazards. First aid kit had all the required elements including tweezers, thermometer, and scissor as well as a first aid manual. LPAs observed no toxins unsecured. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. CONTINUED ON LIC 809C DATED 08/05/2025 LPAs observed an evacuation chair in each stairwell. Smoke detectors and carbon monoxide detectors are tested monthly in-house. Fire inspections are conducted by an outside company, Alarm and Sprinkler Company with the last inspection date of 06/16/2025. Fire extinguishers are fully charged. LPAs toured the outside grounds and there is multiple patio areas. LPAs observed ample emergency food and water. LPAs reviewed the emergency disaster plan during the visit. Plan is thorough and complete. Facility provides activities in the form of games, exercise, and crafts. LPAs observed residents participating in activities during the visit. At 11:00 AM, LPAs reviewed resident and staff files. Resident files contained required documents including admission agreements, physician reports and resident appraisals. Three out of three residents with bed rails do not have corresponding physician orders for bed rails. Resident 1 (R1) is non-ambulatory per physician report dated 10/15/2024 and is residing on the second floor. Per facility license, non-ambulatory residents must be housed on the first floor. LPAs reviewed staff files. LPA observed three out of six staff files did not contain proof of required annual training. LPAs observed Staff #7 and 8 are on-site from the skilled nursing and do not have criminal record clearance. LPAs were provided copies of health screenings by a staff from the skilled nursing side which were determined to be falsified. LPAs reviewed select medications during the visit. Medications are secured in a medication cart and facility uses an electronic medication administration record. Based on the observations made during today’s visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided as well as appeal rights.the state’s words, verbatim · CDSS document, Aug 5, 2025

Allegation investigated: Resident's window is broken Resident's shirt was soaked in urine

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 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.the state’s words, verbatim · CDSS document, Jul 18, 2025 · control 22-AS-20250711132039

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Jul 19, 2025

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.the state’s words, verbatim · CDSS document, Jul 18, 2025

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

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Aug 1, 2025

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.the state’s words, verbatim · CDSS document, Jul 18, 2025

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

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit in conjunction with complaint visit 22-AS-20250711132039. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the complaint investigation, LPA observed that Staff 1(S1) is not fingerprint cleared. Based on the observations made during today's visit, the following violation is being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report as well as appeal rights were discussed and provided with facility representative.the state’s words, verbatim · CDSS document, Jul 18, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Jul 19, 2025

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 ASSESSEDthe state’s words, verbatim · CDSS document, Jul 18, 2025

Plan of correction: Licensee took S1 to get a clearance during the visit. License to forward clearance to LPA.

Allegation investigated: Staff handle resident in a rough manner

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on the investigation of the allegation listed above and to deliver findings in the investigation. An initial investigation visit took place on May 5, 2025. During the visit, LPA requested the facility resident census, employee roster as well as the staff schedule for the day of the visit. Records were requested for a total of five residents and reviewed. LPA accompanied by staff toured the two levels of the facility. LPA additionally conducted five resident interviews and two staff interviews during the visit. Four additional witness interviews were conducted or attempted over the course of the investigation. During the follow-up visit, LPA conducted five additional staff interviews and toured the premises accompanied by staff. CONTINUED ON FORM LIC9099-C Unsubstantiated CONTINUED FROM FORM LIC9099 Regarding the allegation that Staff handle resident in a rough manner, the following has been concluded: Observations conducted during both facility visits did not evidence any instance of rough handling by staff during transfers. Seven out of seven staff interviewed denied ever witnessing inappropriate handling during their shifts or having complaints of that nature brought to their attention by facility residents. Two out of five residents interviewed reported hearing complaints from some of their fellow residents, however none of the statements gathered corroborated those statements. All staff present and interviewed confirmed having received adequate training on transfers from the facility's Wellness Director who confirmed in her own statement. No specific instances of rough handling could be identified as a result of observations and statements gathered. Based on the evidence gathered during the investigation, 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.the state’s words, verbatim · CDSS document, Jun 18, 2025 · control 22-AS-20250501152827

Allegation investigated: Due to neglect, resident's health declined

Licensing Program Analysts (LPA) Jerome Haley made an unannounced visit regarding the complaint allegation above. LPA Haley was greeted by staff and explained the reason for the visit upon entry. Before interviews began, LPA toured the interior and exterior patio area of the facility with staff. Staff led LPA Haley to the portion of the Skilled Nursing Facility (SNF) to observe the main kitchen area. Regarding the complaint allegation: Due to neglect, resident's health declined During the investigation, 3 of 4 individuals were successfully interviewed and all three provided information that contradicted the complaint allegation. During an interview with Witness 1 (W1), the witness explained they received an inquiry from a child of Resident 1 (R1) who wanted to R1 to stop taking a medication. Continued on LIC9099C Unfounded W1 explained to the family member that it would not be good to suddenly stop administering the medication and suggested weaning R1 of the medication and the child agreed. However, R1’s other child, Witness 2 (W2) contacted W1 and provided W1 a Medical Power of Attorney (POA) and requested to stop providing medications to R1. At that time W1 went over all the options available to W2, including weaning R1 off medications, Hospice services which W2’s version of Hospice did not match W1’s version of hospice, so W1 explained their only other option was hospitalization. During interviews with Staff 1 (S1) and Staff 2 (S2), both staff members explained they would not comply with a family members request to administer, stop administering, or change the dose of a residents medication. Both staff members explained there must be a doctors order before a medication adjustment can be made. A review of R1's documents show, medications were discontinued, and dosages were lowered at the request of R1's family. During the visit several documents were provided and S1 agrees to email LPA any addition documents needed. Based on the information gathered through interviews and document review, the following allegation: Due to neglect, resident's health declined, is deemed unfounded, meaning the allegation is false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 24, 2025 · control 22-AS-20250117163013

Allegation investigated: Staff administered medication to resident without authorized representative consent

Licensing Program Analysts (LPAs) Jospeh Alejandre and Brandon Lopez made an unannounced visit to conduct the required 10-day visit to begin the investiation into the allegation listed above. LPAs met with Administrator Taylor Clark and explained the reason for the visit. The investigation revealed the following. Resident 1 (R 1) moved into the assisted living facility on June 26, 2023. After R1 moved in, a family member (F1) provided a completed medical power of attorney (POA) dated August 9, 2022 making F1, R1's agent in all matters relating to health care. The Administrator reported that in May 2024 R1 was put on medications after a doctor's visit and F1 agreed. F1 could not be reached to verify this information. R1 continued taking medications and residing at the facility until November 8, 2024 after suffering a fall. R1 was sent to the hospital and from the hospital transferred to a skilled nursing facility (SNF) on November 13, 2024. R1 remained at the SNF until they were discharged to the assisted living facility on January 6, 2025. It was reported that F1 wanted all medications stopped when R1 returned to the assisted living facility. The Adminsitrator reported that the physician's at the SNF had already begun to taper R1's medications at F1's request. Unsubstantiated The Administrator reported that the physicians informed him that stopping the medications for R1 all at once is unsafe. The Administrator reported that R1's medications are being reduced in accordance with doctor's orders because of F1's request to have all medications discontinued. The Administrator reported they are complying with F1's requests while at the same time doing it in accordance with the physician's orders to reduce the medication safely. The Administrator reported that R1 has an appointment with a Nurse Practitioner on January 9, 2025 to evaluate R1 and her medications. A review of records shows R1 was receiving 9 medications at the SNF and currently at the assisted living facility R1 is receiving 6 medications. R1's Risperidone has been reduced from .75 mg at the SNF to .5 mg at the assisted living facility. During the time period from November 8, 2024 until January 6, 2025, R1 was not in the care of the assisted living facility and they had no control over R1's medications. When R1 moved back to the facility on January 6, 2025 the facility followed the medical advise of physicians in regards to getting R1 off of medications in a safe manner to comply with F1's request. There is insufficient evidence to support the allegation. Although the allegation may have happened or is valid; there is not a preponderance of evidence to prove that the alleged violation did or did not occur, therefore the allegation, staff administered medication to resident without authorized representative consent, is unsubstantiated. An exit interview was conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Jan 9, 2025 · control 22-AS-20250102143150

Type of visit: Required - 1 Year

On 12/07/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Med-Tech Nisha Korala who contacted the Administrator Taylor Clark by telephone. LPA Dabuet explained the purpose of today’s visit. The facility is licensed to operate for (84) ambulatory, of which (44) non-ambulatory elderly adults ages 60 and above. The facility is approved for (20) hospice residents. Currently, the facility has (1) resident in hospice care. The facility is a two-story structure located in a commercial neighborhood. It consists of the following: (42) resident bedrooms, (42) resident bathrooms, a med room, a conference room, a dining room, a laundry room, business offices, a kitchen, (3) storage rooms, a staff bathroom, outdoor patio, a salon, and an employee lounge. LPA Dabuet and Clark toured the physical plant. There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident's personal belongings was observed. Bed linens, comforters, and bath towels were stocked during the visit. The resident rooms were inspected: #152, #159, #164, #174, #203, #206, #214 and #218. Bathrooms were operational with water temperature measured at 105.2 – 107.9 degrees F. A comfortable temperature was maintained in the facility at 70 - 74 degrees F. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Fire extinguishers were charged, and smoke detectors and carbon monoxide were operable in each resident's room. Disaster Drill/Evacuation Drill/Fire Drill are conducted monthly with records of !1/12/24 being the last drill. A review of the Medication Records Administration (MAR) was observed to be maintained in order and accurately. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. All mandated inspection control posters were posted including Activities Calendar and Food Menu. LPA conducted an audit of resident #1-#6 (R1-R6) service files, and staff #1-#6 (S1-S6) personnel files were maintained. The facility is current in CCLD annual fees. The administrator certificate for Taylor Clark #6013718740 2/8/2023 - 3/8/2025. The facility has a Liability Insurance Certificate valid with policy #B1881S240359 01/01/24 -01/01/25. The facility as current Surety Bond. DEFICIENCIES: · Resident #7 and #8 (R7-R8) are administered diabetic injection insulin daily by a non-appropriately skilled professional. · Criminal Clearance Transfer Association for staff #1-#5 (S1-S5). No Criminal Clearance Transfer Request LIC 9162 on file or revealed on CDSS Guardian Background System. · Staff #2-#5 (S2-S5) did not have current CPR/First Aid Certificate on file. · Room #164 had a sink cabinet door broken/require repair. · Room #174 and #218 had sharp scissors accessible to residents in care. · Room #206 had cleaning powder bleach accessible to residents in care. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the following deficiencies has been observed and citation issued (ref. LIC 809-D). An exit interview conducted with the Taylor Clark, and a copy of the report is provided. Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) are cleared. *the state’s words, verbatim · CDSS document, Dec 7, 2024

Allegation investigated: Resident's dietary needs are not being met.

On this day Licensing Program Analyst (LPA) Jenifer Tirre made an unannounced visit to iniate complaint investigation. LPA discussed purpose of the visit and allegations with Administrator Taylor Clark. Based on a facility record review and interview with Administrator Investigation revealed that Resident (R1) is a resident at Sea Cliff Healthcare Center Skilled Nursing not Sea Cliff Assisted Living. Sea Cliff Healthcare Skilled Nursing is an entity of California Department of Public Health. This agency has investigated the complaint alleging residents dietary needs are not being met. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without reasonable basis. An exit interview was conducted with Administrator and a copy of report was provided to facility. Unfoundedthe state’s words, verbatim · CDSS document, Apr 26, 2024 · control 22-AS-20240422151705

Allegation investigated: Resident sustained unexplained fracture while in care due to neglect

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced complaint visit to deliver findings on the above allegation received on January 02, 2024. LPA was greeted and granted entry into the facility and met with Administrator (AD) Taylor Clark. LPA explained the reason for the visit. This Department has investigated the complaint alleging that Resident sustained unexplained fracture while in care due to neglect. Resident 1 (R1) was admitted to the facility on October 04, 2022. Documents reviewed included the Physician Report (LIC602) dated August 16, 2023 for R1. Per Physician report R1’s diagnoses are Status post joint replacement surgery, Alzheimer’s, Arthritis, Dementia and is Non-ambulatory. On June 13, 2023, R1 sustained a displaced femoral neck fracture while out of the facility with family. R1 went to a Skill Nursing Facility from June 2023 to August 2023. The Unusual Incident/Injury Report (UIIR) on December 26, 2023, reports R1 had an unwitnessed fall, hit their head and fracture their left femoral. Per the UIIR on December 31, 2023, R1 had an unwitnessed fall and was bleeding from their head. CONTINUED ON LIC9099-C... Unsubstantiated On December 26, 2023, R1 was hospitalized at Hoag Memorial Hospital after an unwitnessed fall and was admitted for left shaft fracture. During the course of the interviews AD stated that on December 26, 2023, R1 fell when they attempted to transfer into their wheelchair and reported that the wheelchair wheels were not locked. Per AD, R1 had surgery on December 27, 2023, and was discharged into the facility on December 28, 2023. On December 31, 2023, R1 was hospitalized at the University of California (UCI) Health after a second unwitnessed fall and was admitted for Traumatic subdural hemorrhage with loss of consciousness. AD reported that on December 31, 2023, R1 had an unwitnessed fall while trying to use the restroom. On January 02, 2024, R1 was discharged from the hospital with a diagnosis of subdural hematoma. Documents reviewed included the UCI Health Discharge Summary dated January 02, 2024, for R1. Per Discharge Summary given the absence of significant mass effect, R1 will not require operative neurosurgical intervention and R1’s staples from the fall need to be removed on January 08, 2024. Documents reviewed included the Hoag Home Health Records dated January 04, 2024, for R1 confirmed receipt of the staple removal order. Based on the investigation, there was no evidence to corroborate the allegation of neglect by staff resulting in R1’s falls and injuries that occurred on December 26 and December 31, 2023. Per physician report the R1 was not a fall risk and 911 was initiated timely and R1 was transported to Hoag Memorial Hospital and UCI Health respectively. Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegation occurred as reported due to insufficient evidence. Therefore, the allegation has been deemed to be UNSUBSTANTIATED. LPA Ramirez conducted an exit interview with AD Clark, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Apr 26, 2024 · control 22-AS-20240102092921

Allegation investigated: Facility staff failed to meet residents’ needs.

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 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.the state’s words, verbatim · CDSS document, Mar 18, 2024 · control 22-AS-20240311130718

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit to deliver findings on an investigation completed by the Department. LPA was greeted and granted entry into the facility by staff. LPA met with Administrator Taylor Clark and explained the reason for the visit. On November 7, 2023, the Department received a self reported incident of possible sexual abuse. The purpose of today’s visit is to follow up on an investigation conducted by the Department regarding the above allegation. The investigation conducted revealed the following: Resident 1 (R1) was admitted to the facility on January 19, 2023. Per Physician report dated April 15, 2023, R1 has a diagnosis of Mild Cognitive Impairment and is able to communicate needs. On November 04, 2023, at approximately 1 PM, R1 reported Staff 1 (S1) entered their room unannounced during which time they found R1 crying on their bed, upset. Upon finding R1 upset, S1 asked R1 if they would like a hug. R1 reported stating yes; however, R1 later reported while hugging them, S1 slid their arm around and began touching R1’s chest and slid a hand underneath R1’s pajamas touching their genital area. R1 stated they attempted to push S1 away which startled them. R1 asked S1 for a large trash bag for their room which caused S1 to get up and retrieve the bag as requested before leaving. R1 reported the incident to caregivers who reported it to Administrator Taylor Clark the following day. The Local Police Department was notified of the incident and a written report submitted to the Department reporting the incident. When interviewed, S1 admitted to giving R1 a hug but denied touching R1 in any inappropriate way. S1’s employment was terminated from the facility on November 10, 2023, due to previous counseling/disciplinary notices in addition to the above mentioned incident. CONTINUED ON 809C Interviews with two of three residents described S1 as friendly and reported they had never been inappropriately touched by a staff member. Therefore, based on interviews conducted and documents reviewed, the allegation is deemed unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted, and a copy of this report and confidential names list was left at the facility.the state’s words, verbatim · CDSS document, Mar 6, 2024