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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604411
Report Date: 10/20/2025
Date Signed: 10/20/2025 10:22:00 AM

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
09/16/2025 and conducted by Evaluator Janet Ngallo
COMPLAINT CONTROL NUMBER: 08-AS-20250916112659
FACILITY NAME:LA MAREA SENIOR LIVINGFACILITY NUMBER:
374604411
ADMINISTRATOR:MATTHEW RYANFACILITY TYPE:
740
ADDRESS:5592 EL CAMINO REALTELEPHONE:
(442) 325-3510
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:125CENSUS: 101DATE:
10/20/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Executive Director Johnathan ThomasTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff are mismanaging residents medications.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Janet Ngallo conducted an unannounced visit to deliver findings regarding the above complaint allegation. LPA introduced themselves and disclosed the purpose of the visit to Executive Director Johnathan Thomas.

On September 16th, 2025, it was alleged that the staff mismanaged resident’s medication. The Department’s investigation consisted of an unannounced facility visit, records review, staff, and outside source interviews. According to the allegation received, Resident #1 (R1) was not given their medication for 9 days. It was alleged that due to R1's lack of medication, R1 showed extreme emotional symptoms. It was alleged that staff notified R1's POA about the medication running out several days after R1 had not been taking said medication.

[Continued on LIC9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2025
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 3
Control Number 08-AS-20250916112659
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: LA MAREA SENIOR LIVING
FACILITY NUMBER: 374604411
VISIT DATE: 10/20/2025
NARRATIVE
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Review of facility records revealed that facility staff had self reported this medication error for R1 to the department on September 18th, 2025. The records reviewed stated that on 09/08/2025, R1 ran out of their medication, and medication was not delivered until 09/15/2025. Interviews with staff and outside sources all corroborated that R1 had not been given medications for several days. R1 did have some emotional adverse reactions presumably due to the lack of medication.

The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of evidence exists to support the allegation. One deficiency is being cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). An exit interview was conducted with Executive Director Johnathan Thomas, to whom a copy of this report, LIC 9099-C, LIC 9099-D, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 08-AS-20250916112659
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: LA MAREA SENIOR LIVING
FACILITY NUMBER: 374604411
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/20/2025
Section Cited
CCR
87465(a)(4)
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87465 Incidental Medical and Dental Care: "(a)(4) The licensee shall assist residents with self-administered medications as needed." This requirement was not met as evidenced by:
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Licensee will conduct an in-service training due on 10/23/2025 as a result of the medication error. Licensee will provide proof of training with sign-in sheet and training topic.
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Based on interview and record review, the licensee did not comply with the sections cited above as one(1) out of one hundred and twenty-five(125) residents did not recieve medication, which posed a potential health and safety risk to persons in care.
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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: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3