374604300-6-2-2025-08-AS-APAO-DHJQTX-20250611122753

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604300
Report Date: 06/02/2025
Date Signed: 06/02/2025 09:45:32 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
05/12/2025 and conducted by Evaluator Rebecca A Borunda

COMPLAINT CONTROL NUMBER: 08-AS-20250512112409

FACILITY NAME:	OCEANSIDE SENIOR LIVING		FACILITY NUMBER:	374604300
ADMINISTRATOR:	JOHNSON, KRISTELANGELICA		FACILITY TYPE:	740
ADDRESS:	5508 AVENIDA PACIFICA WAY		TELEPHONE:	(760) 978-6602
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92057
CAPACITY:	165	CENSUS: 106	DATE:	06/02/2025
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Executive Director Kristel Johnson		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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Licensee did not provide resident with a refund

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Executive Director Kristel Johnson.

The Department’s investigation consisted of interviews with residents, staff, and outside sources and review of facility records. It was alleged that the facility did not provide Resident 1 (R1) with a refund. Review of R1’s financial ledger and interviews with staff, outside sources, and R1 revealed that on 5/1/2025, the facility received an electronic payment for R1’s basic services for May from R1’s bank account. Interviews also revealed that sometime in early May 2025, R1’s responsible party provided the facility with a physical check for R1’s basic services rate for May, which was supported by interviews with facility management. The physical check was entered into R1’s financial ledger logs on 5/6/2025.

Continued on LIC9099-C page...

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2025

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-20250512112409

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: OCEANSIDE SENIOR LIVING	FACILITY NUMBER: 374604300
	VISIT DATE: 06/02/2025

NARRATIVE

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Interviews with R1 and outside sources revealed that R1 and their responsible party had multiple discussions with facility management, including the Executive Director (ED) regarding refunding one of the payments. Review of email communication between facility staff and the facility corporate office revealed that on 5/6/2025, the Business Office Manager sent an email to the corporate billing office explaining the situation including that R1’s responsible party had requested a refund check, not a credit to their billing account, and that the facility was requesting a refund of one of the payments. Between 5/9/2025 and 5/16/2025, the ED sent multiple emails requesting follow-up on the refund request for R1 with no response from the corporate office. On 5/20/2025, the basic service rate for June 2025 posted in the facility’s electronic billing system, which automatically applied the overpayment for May 2025 to the June charges. Emails from the corporate office on 5/21/2025 stated that because the June charges had already been added to the billing system and R1’s financial ledger showed a balance of $0, the facility was unable to refund R1’s overpayment from May 2025.

As of 6/2/2025, the facility has not issued R1 or their authorized representative a refund check for the overpayment for May 2025. Facility management did not deny during interviews that the facility received two payments for R1’s basic service rate for the month of May and that R1’s account showed an overpayment between 5/6/2025 and 5/20/2025. Review of R1’s admission agreement signed 3/27/2025 revealed that according to the facility’s refund policy regarding unused portions of the monthly fee, any extra money would be refunded within 30 days of the termination of the agreement upon relocation from the facility or resident death. However, R1’s agreement was still valid as of 6/2/2025, since R1 had not relocated from the facility or had died. Review of regulations did not reveal any regulations that would require the facility to issue a refund check instead of applying the overpayment to future billing charges.

The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated.

An exit interview was conducted with Executive Director Kristel Johnson, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2025

LIC9099 (FAS) - (06/04)

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