374604300-2-24-2026-08-AS-SMOA-DRSSH4-20260302125256

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604300
Report Date: 02/22/2026
Date Signed: 02/24/2026 05:32:41 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
05/19/2025 and conducted by Evaluator Sarah Hurt

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20250519111234

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: 92	DATE:	02/22/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Facility Business Office Manager, Virginia Rodriguez		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Lack of supervision resulting in elopement and injury

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to deliver findings on a complaint investigation. LPA Hurt met with Facility Business Office Manager, Virginia Rodriguez, and explained the purpose of today’s visit.

Regarding the allegation of lack of supervision resulting in elopement and injury, the investigation determined that on 05/17/2025 at approximately 12:00 AM, resident 1 eloped from the facility and was found outside with injuries including a hematoma and a laceration. Facility staff intervened, and Resident 1 was transported to Tri-City Hospital for evaluation and treatment. Staff and administrative interviews confirmed that Resident 1 had wandered on multiple prior occasions (including an incident on 04/04/2025), and facility records show a care plan meeting was held on 05/14/2025 to discuss moving her to the Memory Care unit due to her exit-seeking behavior. Despite the identified need for a higher level of care, the resident was not relocated immediately, reportedly due to hesitation from her family. Investigators concluded that the resident clearly required more supervision than was being provided in Assisted Living and should have been moved to a secured Memory Care environment sooner to ensure her safety. Based on interviews conducted, and records reviewed the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED.

The following deficiencies are being cited (see LIC 9099D) from the California Code of Regulations, Title 22, and the California Health and Safety Code. This incident is currently under review and a future civil penalty may apply based on H&S Code section 1569.49(f). Failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted with Facility Business Office Manager, Virginia Rodriguez, and appeal rights provided.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2026

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-20250519111234

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: 02/22/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/23/2026 Section Cited CCR 87464(f)(1)	1 2 3 4 5 6 7	87464 Basic Services (a) The services provided by the facility shall be conducted so as to continue and promote, to the extent possible, independence and self-direction for all persons accepted for care. Such persons shall be encouraged to participate as fully as their conditions permit in daily living activities both in the facility and in the community.(f) Basic services shall at a minimum include:(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). The following requirement has not been met as evidenced by:	1 2 3 4 5 6 7	Administrator will provide training to all staff on elopement prevention, including identifying residents at risk of elopement, supervision expectations, monitoring of exits, and appropriate respone when a resident attempts to leave the facility unsupervised. Training will also include reporting and documentation process, and submit to LPA by POC date of 02/23/2026.
	8 9 10 11 12 13 14	Based on interviews conducted Resident1 eloped from the facility resulting in injury, which poses an immediate health, safety, or personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: See Moua
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

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
05/19/2025 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 08-AS-20250519111234

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: 92	DATE:	02/22/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Facility Business Office Manager, Virginia Rodriguez		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

1
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9

Dining dishware was not maintained in good repair

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2026

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

LIC9099 (FAS) - (06/04)

Page: 3 of 3