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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604300
Report Date: 10/30/2025
Date Signed: 10/30/2025 03:21:34 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
06/13/2025 and conducted by Evaluator Rebecca A Borunda
COMPLAINT CONTROL NUMBER: 08-AS-20250613163403
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: 98DATE:
10/30/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Executive Director Kristel JohnsonTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Licensee did not issue a refund
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 interviewed Executive Director.

The Department’s investigation consisted of interviews with staff and outside sources, records review, and a tour of the facility. The Department was unable to interview R1 due to R1’s death sometime in 2025.
It was alleged that the Licensee did not issue a refund. Review of R1’s charting notes revealed that R1 moved into the facility on 1/31/2024 and moved out of the facility on 4/7/2024. R1’s financial ledger revealed that R1’s responsible party paid a community fee of $4,000 upon move-in.

Continued on LIC9099-C page...
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
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 5
Control Number 08-AS-20250613163403
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: 10/30/2025
NARRATIVE
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The facility’s admission agreement stated that individuals who moved out of the facility within 3 months of admission would be entitled to a 40 percent refund of the community fee, minus $500, which amounted to $1,400. Review of R1’s financial ledger and interviews with facility management revealed that a $1,400 refund was processed and refunded in June 2025, which exceeds the time frame set by regulation.

The Department has investigated the above-mentioned allegation and based on interview and record review, the preponderance of the evidence has been met, therefore, this allegation is deemed substantiated. The following deficiency is cited per CA Code of Regulations Title 22 and noted on the attached LIC9099-D page.

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 03/22).
SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20250613163403
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/26/2025
Section Cited
CCR
87507(g)(5)(E)(3)(c)
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87507(g)(5)(E) Preadmission fees shall be refunded according to the following conditions:(3)... paid preadmission fees greater than five hundred dollars ($500) shall be refunded... as follows: (c) Refunds... shall be paid within 15 days of issuing the notice...
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Licensee already issued $1,400 refund to R1 and their responsible party. Executive Director and Business Office Manager will receive training on refunds and provide proof of training to the Department by POC due date of 11/26/2025.
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This requirement has not been met as evidenced by:
Based on interview and record review, the licensee did not ensure that R1 was issued a refund of their pre-admission fee within 15 days of notice. This poses a potential personal rights risk to R1.
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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: Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
06/13/2025 and conducted by Evaluator Rebecca A Borunda
COMPLAINT CONTROL NUMBER: 08-AS-20250613163403

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: 98DATE:
10/30/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Executive Director Kristel JohnsonTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not administer medication as prescribed
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 interviewed Executive Director.

The Department’s investigation consisted of interviews with staff and outside sources, records review, and a tour of the facility. The Department was unable to interview R1 due to R1’s death sometime in 2025. It was alleged that staff did not administer medications to Resident 1 (R1) as prescribed. Interviews and R1’s admission documents dated January 2024 revealed that R1 was admitted to this facility from a different facility on 1/31/2024. Additionally, some of R1’s paperwork, including medication lists and physician’s orders, were received from the previous facility.
Continued on LIC9099-C page...
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20250613163403
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: 10/30/2025
NARRATIVE
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Review of R1’s physician’s orders in January 2024 revealed that R1 had a medication order for Escitalopram and Amitriptyline which were both ordered on 1/18/2024 and discontinued on 1/31/2024. Review of R1’s needs and services plan and medical assessment dated January 2024 revealed that R1 was unable to administer prescription medication independently and was receiving medication management from facility staff.

Review of the facility’s charting notes and faxes sent to R1’s physicians revealed that on 2/12/2024, the Resident Services Director (RSD) notified R1’s physicians via fax that R1 had not been taking Escitalopram and Amitriptyline since 1/30/2024 and requested physician advice on R1 restarting the medications at the previous dose and requested a written physician order for both medications. RSD received written medication orders for Escitalopram on 2/13/2024. RSD reached out to R1’s physicians daily regarding the Amitriptyline medication until the RSD received a written medication order for Amitriptyline on 2/16/2024. Interviews and review of R1’s medication administration record (MAR) revealed that R1 began receiving Escitalopram on 2/14/2024 and Amitriptyline on 2/16/2024.

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: Sabel Martinez
LICENSING EVALUATOR NAME: Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5