198320433-9-5-2025-11-AS-UCOL-DN7QZ4-20251107113608

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320433
Report Date: 09/05/2025
Date Signed: 09/05/2025 04:47:37 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
08/28/2025 and conducted by Evaluator Mario Leon

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250828152822

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: 48	DATE:	09/05/2025
		UNANNOUNCED	TIME BEGAN:	08:32 AM
MET WITH:	Gloriella Jara, Executive Director		TIME COMPLETED:	05:03 PM

ALLEGATION(S):

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Staff did not follow proper eviction protocol
Staff confines residents inside of the facility
Staff do not maintain facility in good repair
Staff do not ensure that doors are free of obstruction
Staff do not assist residents with obtaining medical care
Staff do not monitor residents for change in condition

INVESTIGATION FINDINGS:

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On 09/05/25 Licensing Program Analyst (LPA) Mario Leon conducted an unannounced initial complaint visit at the facility. LPA was met by staff two Salina Cruz, Care director (S2) and later by staff one Gloriella Jara, Executive director (S1) and the purpose of the visit was explained.
The investigation consisted of the following:
On 09/04/25, between 08:20AM and 12:05PM, LPA requested facility documents, including resident and staff roster (dated 08/22/25), Facility sketch (dated: 05/29/25) and toure the facility. LPA interviewed two (2) out of thirty-seven (37) staff. On 09/05/25, between 08:20AM and 2:15PM, LPA interviewed one (1) witness (W1), two (2) staff and five (5) residents and requested records of three (3) staff and any crossover notes.
The investigation revealed the following:
Regarding the allegation, “staff did not follow proper eviction protocol”, it is being alleged that the facility has not provided actual eviction letters to residents. Interviews revealed that all four (4) staff (S1-S4) have confirmed that the tenants who are living in the "Old Serenity Village" are living independently of the care and supervision of staff at the facility. Report continues, please see LIC9099-C.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025

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 11-AS-20250828152822

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: 09/05/2025

NARRATIVE

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All five residents (R1-R5) have confirmed they have not received any eviction notice. Witness one (W1) has revealed two (2) names of the reporting parties. Record reviews revealed the following: Eviction notice(s) were requested of any eviction to resident(s) in care. When requested these alleged document(s) were not available during today's visit. Furthermore, the names provided by W1 were not present on the resident roster (LIC9020) nor on the in-house resident roster. Based on 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, “staff confines residents inside of the facility”, it is being alleged that the facility places chairs, indoors, against entrance and exit door knobs which prevents residents to depart from the facility. Interviews have revealed the following: three (3) out of four (4) staff (S1-S2, S4) and all five residents (R1-R5) have denied the allegation has taken place. On 09/05/25, at 10:39AM, LPA's observation revealed the following: LPA observed chairs placed in front of the "original front entrance" (OFE). Staff three (S3) agreed that they have seen chairs placed in front of OFE, yet also stated the following, "Whoever has done that MUST be a resident. I know it was a resident because I saw (revealed name) putting the chairs there 'to help keep the facility safe'. Theyhave since moved out, but there is no way a staff is doing that. I can guarantee you it is still a resident doing that, because we have all been trained not to block any entrance/exit door(s)." Based on LPA's interviews and LPA's observation(s) 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, “staff do not maintain facility in good repair”, it is being alleged that the fire alarm goes off at least twice a week, for no reason. Interviews have revealed the following: all four staff (S1-S4) have confirmed that the fire alarm was emitting an alarm quite often. S2 stated the following, "We have had that repaired, but we’re waiting to receive the report from the fire department who had come on the same day as our annual visit by LPA Dabuet.". LPA Leon attempted to contact LPA Dabuet to confirm this statement. LPA Dabuet was not available for contact. Record reviews were not available to confirm this statement. All five residents (R1-R5) have confirmed that the fire alarm system has not bothered them; that since the fire department has visited, the alarm has not gone off again and that they are prepared to leave the facility in case of fire. During LPA's one-and-a-half (1.5) days at the facility, LPA has not heard nor observed the fire alarm. Report continues, see LIC9099-C.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20250828152822

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: 09/05/2025

NARRATIVE

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Based on interviews conducted and LPA's observation(s), 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, “staff do not ensure that doors are free of obstruction”, it is being alleged that the facility places chairs, indoors, against entrance and exit door knob(s). Interviews have revealed the following: three (3) out of four (4) staff (S1-S2, S4) and all five residents (R1-R5) have denied the allegation has taken place. On 09/05/25, at 10:39AM, LPA's observation revealed the following: LPA observed chairs placed in front of the "original front entrance" (OFE). Staff three (S3) agreed that they have seen chairs placed in front of OFE, yet also stated the following, "Whoever has done that MUST be a resident. I know it was a resident because I saw (revealed name, date unknown) putting the chairs there “to help keep the facility safe”. Theyhave since moved out, but there is no way a staff is doing that. I can guarantee you it is still a resident doing that, because we have all been trained not to block any entrance/exit door(s). Record reviews have revealed the following: While LPA reviewed the resident roster, the revealed nameis no longer listed which indicate revealed namehas since moved out of the facility. While LPA's observation confirms the alleged violation has taken place, LPA has decided this observation has not been conducted by a staff member, as S3 has confirmed "Staff six (S6) even asked me, 'What's up with the chairs at the door?'. So, no, it was not the staff who had done that. It was some resident who ‘wanted to help'." Based on interviews, LPA observation(s) and record reviews 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, “staff do not assist residents with obtaining medical care”, it is being alleged that residents have fallen and there is no staff available to assist residents after their fall. Interviews have revealed the following: All four (4) staff (S1-S4) and four (4) out of five (5) residents (R1, R2, R4, R5) have denied the allegation has taken place. On 09/05/25, from 11:30AM through 12:00PM, LPA observed servers providing all care to residents during today's barbeque in the outdoor, shaded, patio. Record reviews have revealed the following: All four staff (S1-S4) are associated to the facility and have conducted sufficient hours under Title 22, Division 6, Chapter 8, Article 07. Personnel. 87407, 87411 and 87412. Based on interviews, LPA observation(s) and record reviews 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.

Report continues, see LIC9099-C.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20250828152822

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: 09/05/2025

NARRATIVE

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Regarding the allegation, “staff do not monitor residents for change in condition”, it is being alleged that staff do not seek medical care for residents in care. Interviews have revealed the following: All four (4) staff (S1-S4) and four (4) out of five (5) residents (R1, R2, R4, R5) have denied the allegation has taken place. Record reviews have revealed the following: All four staff (S1-S4) are associated to the facility and have conducted sufficient hours under Title 22, Division 6, Chapter 8, Article 07. Personnel. 87407, 87411 and 87412. Crossover notes (dated 08/15/25 through 09/04/25) have presented numerous crossover notes in order to ensure the health and safety of residents in care have been provided to residents in care. Based on interviews, LPA observation(s) and record reviews 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 - Executive Director and a copy of this report has been provided.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025

LIC9099 (FAS) - (06/04)

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