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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604300
Report Date: 06/02/2025
Date Signed: 06/02/2025 04:03:44 PM

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
04/04/2025 and conducted by Evaluator Rebecca A Borunda
COMPLAINT CONTROL NUMBER: 08-AS-20250404152940
FACILITY NAME:OCEANSIDE SENIOR LIVINGFACILITY NUMBER:
374604300
ADMINISTRATOR:JOHNSON, KRISTELANGELICAFACILITY TYPE:
740
ADDRESS:5508 AVENIDA PACIFICA WAYTELEPHONE:
(760) 978-6602
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:165CENSUS: 106DATE:
06/02/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Executive Director Kristel JohnsonTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff did not allow resident to choose to participate in activities
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced complaint visit to conduct follow up and 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. During today's visit, LPA toured the facility, observed residents in care, and interviewed residents and staff.

The Department's investigation consisted of interviews with residents, staff, and outside sources, records review, and a tour of the facility. It was alleged that staff did not allow resident to choose to participate in activities, specifically that Resident 1 (R1) was not allowed to choose which activity to attend. Interviews with staff revealed that R1 was forgetful and required reminders to attend activities. Interviews with staff and outside souces revealed that sometime in April 2025, R1 was attending a movie activity in the facility's theater.

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)
Page: 1 of 2
Control Number 08-AS-20250404152940
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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Another resident, Resident 2 (R2) told R1 that R1 would miss a different activity that occurred at approximately the same time and attempted to make R1 leave the movie activity. This interaction with R2 caused R1 to become confused and agitated. The Activity Director (AD) was able to calm R1 down and asked R2 to allow R1 to make their own decisions regarding which activity to attend. Staff stated during interviews that AD provides R1 with reminders on which activities are happening around the facility and R1 would choose which activity to attend. On that occasion, R1 attended half of the movie activity and attended the other activity afterward.

Interviews with R1 did not reveal any relevant information regarding R1's participation in activities due to R1's cognitive state, which was supported by R1's assessment records dated October 2024 and interviews with staff. Interviews with other residents did not reveal any information that supported the allegation. Interviews with the AD revealed that they held monthly meetings for residents to make activity suggestions and was in regular communication with the members of the resident council regarding activities.

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 Resident Services Director Loida Baskins, 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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