374604738-12-30-2025-08-AS-JROO-DQRUU6-20260128145302

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604738
Report Date: 12/30/2025
Date Signed: 12/30/2025 03:36:16 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
05/23/2025 and conducted by Evaluator Rebecca A Borunda

COMPLAINT CONTROL NUMBER: 08-AS-20250523102111

FACILITY NAME:	BLUE SKIES OF THE VALLEY		FACILITY NUMBER:	374604738
ADMINISTRATOR:	GAMAB, LAURICE		FACILITY TYPE:	740
ADDRESS:	4676 MARBLEHEAD BAY DR.		TELEPHONE:	(619) 208-7869
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92057
CAPACITY:	6	CENSUS: 6	DATE:	12/30/2025
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Caregiver William Punta		TIME COMPLETED:	10:20 AM

ALLEGATION(S):

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Lack of Supervision, resulting in hospitalization

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Caregiver William Punta.

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 lack of supervision resulted in the hospitalization of Resident 1 (R1). Interviews with staff and outside sources and review of medical paperwork revealed that R1 moved into the facility on 5/17/2025 following an admission to a skilled nursing facility. According to R1’s medical and pre-admission assessment documents, R1 was assessed to require the use of a wheelchair, staff assistance with all activities of daily living, and assistance with medication management.

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: 12/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025

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-20250523102111

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: BLUE SKIES OF THE VALLEY	FACILITY NUMBER: 374604738
	VISIT DATE: 12/30/2025

NARRATIVE

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Interviews revealed that on 5/20/2025, three days following R1’s admission to the facility, R1 was observed to have a change in condition, which resulted in emergency services being contacted and R1 was transported to the hospital. Medical records from R1’s hospitalization showed that toxicology results revealed that R1’s urine analysis was positive for fentanyl. Review of R1’s medical records revealed that R1 was not administered fentanyl during emergency services transport or while at the hospital prior to the toxicology test.

Review of the medication lists for all residents at the facility, including for R1, did not reveal any medications that contained fentanyl. During interviews, staff denied any knowledge of the existence of any medications containing fentanyl in the facility, including medications prescribed to live-in staff. Staff also denied knowledge of how R1 could have been exposed to fentanyl while at the facility.

Review of R1’s toxicology report confirmed that medications of a similar chemical structure to fentanyl could cause a false positive on testing. Interviews with medical professionals denied that any of R1’s prescribed medications could cause a false positive for fentanyl. Clinical consultants of the Department also reviewed R1’s medications and confirmed that none of R1’s prescribed medications could cause a false positive for fentanyl. Additionally, medical professionals stated that fentanyl is generally prescribed in patches applied to the skin and other forms of administration such as liquids or pills are rarely prescribed. R1’s toxicology report stated that the test was “unconfirmed screening results” used to assist in managing medical care and additional testing would need to be done to confirm the result. Review of R1’s medical records did not reveal any evidence that confirmatory testing was ordered to verify if the test was accurate.

The Department has investigated the above-mentioned allegation and based on interviews and records review showing a lack of evidence of mismanagement of medications and a lack of explanation of how R1 tested positive for fentanyl, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated.

An exit interview was conducted with Caregiver William Punta, 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: 12/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025

LIC9099 (FAS) - (06/04)

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