198320433-5-22-2025-11-AS-UCOL-DK8TGY-20250804144356

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320433
Report Date: 05/22/2025
Date Signed: 05/22/2025 04:25:41 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/14/2025 and conducted by Evaluator Mario Leon

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250514084434

FACILITY NAME:	OCEANVIEW LIVING OF SAN PEDRO		FACILITY NUMBER:	198320433
ADMINISTRATOR:	SABINA NAYBERG		FACILITY TYPE:	740
ADDRESS:	2100 SOUTH WESTERN AVENUE		TELEPHONE:	(310) 548-0625
CITY:	SAN PEDRO	STATE: CA	ZIP CODE:	90732
CAPACITY:	86	CENSUS: 32	DATE:	05/22/2025
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Gloriella Jara - Administrator		TIME COMPLETED:	04:46 PM

ALLEGATION(S):

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Facility does not ensure that residents' dietary needs are met.
Food provided to residents lacks nutritional value.

INVESTIGATION FINDINGS:

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On 05/22/25 Licensing Program Analyst (LPA) Mario Leon conducted an initial complaint visit at the facility. LPA was met by staff one, Gloriella Jara - Administrator (S1) and the purpose of the visit was explained.
The investigation consisted of the following:
On 05/22/25 LPA requested and reviewed facility documents, including resident and staff rosters and five (5) drmodified diet orders, weekly food menu from February the twenty-fourth (02/24/25) through June the first (07/01/25) of this year. LPA toured the ground floor and first (1st) level of the facility, including the kitchen, dining room and six (6) resident rooms. LPA interviewed six (6) out of thirty-two (32) clients and four (4) out of thirty-three (33) staff.
The investigation revealed the following:
Regarding the allegation, “Facility does not ensure that residents' dietary needs are met.”, it is being alleged that residents are not being provided alternative meals. Between 09:30AM and 1:30PM LPA interviewed six (6) out of thirty-two (32) residents (R1-R6) and five (5) out of thirty-three (33) staff (S1-S5).

Report continues, please see 9099-C.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025

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 11-AS-20250514084434

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: OCEANVIEW LIVING OF SAN PEDRO	FACILITY NUMBER: 198320433
	VISIT DATE: 05/22/2025

NARRATIVE

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During today's visit, LPA toured the kitchen and observed at least three (3) days of perishable foods and seven (7) days non-perishable foods. All food is being stored correctly, and dated, which meet Title 22 regulations. LPA also observed a salad bar, with items being provided which include two (2) types of salad and fresh fruit. LPA observed lunchtime schedule, as at least six (6) residents were assisted by at least three (3) serving staff and LPA observed a resident being provided a second serving after their request. Record reviews revealed that residents with a modified diet are posted in staff two, Carlos Gonzales' Kitchen Supervisor's (S2) office. LPA also observed modified diet meals for the residents presenting both a Dr.'s order modified diet and the facility also follows resident preference(s), which indicates staff are providing modified diets prescribed by a resident's physician as a medical necessity to residents in care. Interviews revealed that five (5) out of six (6) residents and all five (5) staff do not agree with the allegation. Based on LPA's observations, record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.

Regarding the allegation, “Food provided to residents lacks nutritional value.”, it is being alleged that residents’ dietary restrictions are not being met. During today's visit, LPA toured the kitchen and observed at least three (3) days of perishable foods and seven (7) days non-perishable foods. All food is being stored correctly, and dated, which meet Title 22 regulations. LPA toured the dining room during lunch hours, which run from 11:30AM - 1:30PM and observed some residents being delivered food at each resident's assigned seating, while residents who are ambulatory (can walk) lined up at the lunch buffet to be served their food. LPA also observed a salad bar, with items being provided such as two (2) types of salad and fresh fruit. Residents were assisted by at least three (3) serving staff and LPA observed a resident being provided a second serving upon request. Record reviews revealed that residents with a modified diet are posted in staff two, Carlos Gonzales' Kitchen Supervisor's (S2) office. LPA also observed modified diet meals for the residents presenting a Dr.'s order modified diet and the facility also follows resident preference(s), which indicates facility staff are providing modified diets prescribed by a resident's physician as a medical necessity are being provided to residents in care. Interviews revealed that all six (6) residents and all five (5) staff do not agree with the allegation.

Report continues, see LIC9099-C.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20250514084434

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: OCEANVIEW LIVING OF SAN PEDRO	FACILITY NUMBER: 198320433
	VISIT DATE: 05/22/2025

NARRATIVE

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Staff two (S2) stated that "we learn who each resident is and follow their Dr's order and their requests..." and resident one (R1) stated "Promises made, promises kept." and has verified they are now satisfied with the changes that have occurred over the past seven (7) days. Based on LPA's observations, record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.

There have been zero (0) deficiencies cited during today's visit.

An exit interview was held with staff one, Gloriella Jara Administrator (S1), and a copy of this report has been provided.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025

LIC9099 (FAS) - (06/04)

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