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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 236804186
Report Date: 11/01/2024
Date Signed: 11/01/2024 11:29:36 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/29/2024 and conducted by Evaluator Christopher Arnhold
COMPLAINT CONTROL NUMBER: 21-AS-20241029131525
FACILITY NAME:OCEANSIDE RETIREMENT LIVINGFACILITY NUMBER:
236804186
ADMINISTRATOR:GYURICS, TUNDEFACILITY TYPE:
740
ADDRESS:100 S HAROLD STREETTELEPHONE:
(916) 616-7020
CITY:FORT BRAGGSTATE: CAZIP CODE:
95437
CAPACITY:4CENSUS: 3DATE:
11/01/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Kathy KabaiTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff did not allow a resident to leave the facility.
INVESTIGATION FINDINGS:
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At approximately 9:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to open an investigation into the above allegation. LPA met with Administrator Kathy Kabai, interviewed residents and reviewed records. LPA received copies of documents.
Based on interviews conducted, Licensee did not allow resident to leave the facility. On 10/27/2024, Resident expressed a desire to visit a family member and had transportation secured. Facility staff refused to allow resident to leave. After several conversations with CCLD and the Ombudsman's office, Licensee agreed they were wrong and agreed to take resident to visit their family. LPA provided a copy of regulation 87468.1, Personal Rights of Residents in all facilities for review.
Based on the Departments investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.
Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
This report was reviewed with Kathy Kabai and Appeal rights were given.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 21-AS-20241029131525
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: OCEANSIDE RETIREMENT LIVING
FACILITY NUMBER: 236804186
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/04/2024
Section Cited
CCR
87468.1(6)
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87468.1 Personal Rights of Residents in All Facilities: (6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This requirement is not met as evidenced by: Based on interviews conducted, Licensee did not allow resident
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Licensee shall review personal rights regulation and retrain all staff on personal rights. Licensee shall submit signed statement from all staff, to CCLD that they have read and understand the regulation. Signed statement shall be submitted to CCL by POC date of 11/04/2024.
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to leave the facility. This poses an immediate personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024
LIC9099 (FAS) - (06/04)
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