374604407-5-28-2025-08-AS-APAO-DH9LFD-20250602084255

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604407
Report Date: 05/05/2025
Date Signed: 05/28/2025 02:24:05 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
07/22/2021 and conducted by Evaluator Becky Kennedy

COMPLAINT CONTROL NUMBER: 08-AS-20210722142429

FACILITY NAME:	BAYSHIRE CARLSBAD		FACILITY NUMBER:	374604407
ADMINISTRATOR:	HIGHTOWER, SASHA		FACILITY TYPE:	741
ADDRESS:	3140 EL CAMINO REAL		TELEPHONE:	(760) 720-9898
CITY:	CARLSBAD	STATE: CA	ZIP CODE:	92008
CAPACITY:	125	CENSUS: 109	DATE:	05/05/2025
		UNANNOUNCED	TIME BEGAN:	09:56 AM
MET WITH:	Ozz Daynes		TIME COMPLETED:	09:57 AM

ALLEGATION(S):

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Staff did not treat resident with dignity.
Staff did not safeguard resident(s) confidential information.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Becky Kennedy conducted a visit to the faility to deliver findings on the above allegations. LPA identified herself and met with Ozz Daynes, Executive Director, and explained the reason for the visit.

The Department’s investigation consisted of review of facility records, outside source records, and interviews w facility staff and outside sources.

It was alleged that facility staff did not treat a resident with dignity. The investigation revealed through interviews and a review of documents that resident 1 (R1) was receiving hospice services. Facility staff observed R1 and did not see signs of life. Facility staff contacted the hospice agency and informed them of their observations. The hospice agency contacted the family and informed them that R1 had died. When R1’s family and hospice staff came to the facility they found that R1 was alive.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Icela Estrada
LICENSING EVALUATOR NAME: Becky Kennedy
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2025

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-20210722142429

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: BAYSHIRE CARLSBAD	FACILITY NUMBER: 374604407
	VISIT DATE: 05/05/2025

NARRATIVE

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Interviews revealed that the regular practice is for hospice to confirm a death prior to contacting the family. In this instance, the hospice agency staff contacted the family prior to confirming that R1 had passed away. Although this is an unfortunate incident, the facility staff operated within their roll and responsibility by alerting the hospice agency regarding their observations. This allegation is unsubstantiated.

It was also alleged that facility staff did not safeguard resident(s) confidential information, by having the door to the medication room at the facility unlocked and unattended. Through interviews it was determined that this allegation was made second-hand. The investigation could not locate anyone with direct knowledge of the allegation, or under what the circumstances the door may have been unlocked. No evidence was revealed that any confidential information was compromised, nor was that alleged. This allegation is unsubstantiated.

Based on the evidence obtained during the complaint investigation, both allegations above are UNSUBSTANTIATED, meaning there isn’t enough evidence to prove a violation occurred.
An exit interview was conducted with Ozz Daynes, Executive Director; a copy of this report and Licensee's Rights (LIC9058) were provided to the facility.

SUPERVISORS NAME: Icela Estrada
LICENSING EVALUATOR NAME: Becky Kennedy
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2025

LIC9099 (FAS) - (06/04)

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