374602472-4-10-2026-08-AS-APAO-DT78EM-20260415222723

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602472
Report Date: 04/02/2026
Date Signed: 04/10/2026 09:16:18 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/25/2026 and conducted by Evaluator Jose DeLaCruz

COMPLAINT CONTROL NUMBER: 08-AS-20260325110835

FACILITY NAME:	SUN AND SEA ASSISTED LIVING		FACILITY NUMBER:	374602472
ADMINISTRATOR:	AGUSTIN, MHEL J		FACILITY TYPE:	740
ADDRESS:	740 SEVENTH STREET		TELEPHONE:	(619) 429-0633
CITY:	IMPERIAL BEACH	STATE: CA	ZIP CODE:	91932
CAPACITY:	32	CENSUS: 29	DATE:	04/02/2026
		UNANNOUNCED	TIME BEGAN:	11:25 AM
MET WITH:	Executive Director Jay Agustin		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff hit resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose De La Cruz conducted an unannounced visit regarding the above allegation. LPA was greeted by Executive Director Jay Agustin, to whom LPA identified as such and explained the purpose of the visit.

The reporting party (RP) alleged that one resident (R1) was hit in the knee by facility staff.

LPA contacted RP on March 27th, 2026. According to RP, staff member S1 reported the allegation after R1 left the facility for their day program and indicated that R1 was assessed on the same day, with no injuries or discoloration observed. RP stated that R1 did not repeat the allegation to RP. Additionally, an outside source familiar with R1 (OS1) believed that the injury was not caused by a staff member as R1 had provided conflicting accounts of the incident.

[CONTINUED ON LIC9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Jose DeLaCruz
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20260325110835

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SUN AND SEA ASSISTED LIVING	FACILITY NUMBER: 374602472
	VISIT DATE: 04/02/2026

NARRATIVE

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[CONTINUED FROM LIC9099]

On the same date, LPA conducted an unannounced visit to the facility. R1’s records were reviewed which revealed a diagnosis of [INSERT dementia]. During the visit, LPA reviewed staff and resident files, incident reports, and interviewed staff involved. Per staff (S2 and the Executive Director), when R1 returned from the day program, R1 was physically assessed, and no injury, bruising, or bleeding was noted. When questioned about the allegation, R1 denied making any abuse allegations.
On April 02, 2026, LPA interviewed R1’s day program staff member OS2, who initially received the allegation. OS2 corroborated the information provided by RP and reported that R1 had previously made statements such as “someone threw rocks at my head,” later correcting the statement to “it feels like somebody threw rocks at me.”

On the same date, LPA conducted an additional unannounced visit to interview R1 and staff member S1, who reported the allegation. R1 was observed by LPA to be confused and disoriented, as they did not know the time, day, or year. R1 reported knee pain, however, they gave conflicting timelines and explanations, both inconsistent with abuse.

S1 described the chain of events consistently with the statements provided by the Executive Director and S2 during the previous visit.

Based on record reviews, LPA observations, and interviews conducted with RP, the alleged victim, facility staff, and day program staff, the preponderance of evidence standard has not been met. Therefore, the allegation is deemed unsubstantiated. No deficiencies were cited in accordance with the California Code of Regulations.

Report and Appeal Rights were discussed with and provided to Executive Director Jay Agustin. Signature below confirms receipt.

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Jose DeLaCruz
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026

LIC9099 (FAS) - (06/04)

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