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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603190
Report Date: 08/07/2025
Date Signed: 08/07/2025 12:33:15 PM

Substantiated


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
04/29/2025 and conducted by Evaluator Arian Golbakhsh
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20250429101105
FACILITY NAME:ACTIVCARE AT BRESSI RANCHFACILITY NUMBER:
374603190
ADMINISTRATOR:MCDONALD, JASONFACILITY TYPE:
740
ADDRESS:6255 NYGAARDTELEPHONE:
(760) 603-9999
CITY:CARLSBADSTATE: CAZIP CODE:
92009
CAPACITY:80CENSUS: 68DATE:
08/07/2025
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Executive Director Jason McDonaldTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Licensee denied resident visitation.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced visit to conduct a complaint investigation and delivered findings regarding the above mentioned allegation. LPA was welcomed by, identified themselves to, and discussed the purpose of their visit to Executive Director Jason McDonald.

On 04/29/2025, the Department received a complaint where it was alleged that a visitor (identified as V1) for a resident (identified as R1) was denied visitation by the facility on the date of April 26th, 2025. The Department’s investigation consisted of unannounced facility visits, records review, and interviews with staff, residents, and outside sources.

[Continued on LIC 9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
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 3
Control Number 08-AS-20250429101105
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: ACTIVCARE AT BRESSI RANCH
FACILITY NUMBER: 374603190
VISIT DATE: 08/07/2025
NARRATIVE
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[Continued from LIC 9099]

Multiple staff interviews revealed that an internal communication was sent to staff informing them that V1 was to no longer be allowed visitation for R1 due to wishes from R1’s Power of Attorney (POA). Per interviews with staff and Outside Sources, visits from V1 triggered R1 and caused increased aggression from R1 and refusal to take daily medications. While one staff interview indicated that V1 was allowed entry on April 26th and informed that day of the facility’s plan to deny V1 future visits, another staff interview revealed that V1 was informed while visiting the facility on April 19th and denied entry to the facility on the 26th.

File review of visitation logs for R1 corroborate that V1 was given entry to the facility the 19th and no entries were noted for the 26th. Additional file review of R1’s records reveal that R1’s POA does not have express permissions to restrict R1’s visitation. Outside sources interviewed revealed that the facility was informed to deny V1 from visitation based on POA wishes and that the facility has moved to deny V1 visits, despite not having legal authorization to do so. Resident interviews did not reveal any concerns about visitation.

Based on LPA's review of records, interviews with staff, residents, and outside sources, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. A Deficiency is being cited per California Code of Regulations, Title 22, Division 6 on the attached 9099D. An exit interview was conducted with Executive Director McDonald to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20250429101105
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: ACTIVCARE AT BRESSI RANCH
FACILITY NUMBER: 374603190
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/14/2025
Section Cited
CCR
87468.1(a)(11)
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(11)To have their visitors, [. . .] permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon.

This requirement is not met as evidenced by:
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Licensee will conduct review/retraining with staff on residents rights, including visitation, and submit proof to LPA by POC due date.
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Based on interviews and records review, the licensee did not ensure that visitors for R1 were allowed entry, resulting in a personal rights risk to 1 out of 68 residents 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: Sabel Martinez
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3