198320433-1-29-2026-11-AS-UCOL-DSGMW6-20260324095750

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320433
Report Date: 01/29/2026
Date Signed: 01/29/2026 05:02:52 PM

Substantiated

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
01/26/2026 and conducted by Evaluator Jose Anguiano

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20260126231538

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: 66	DATE:	01/29/2026
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Maria Galvan		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff do not have adequate record keeping for the residents

INVESTIGATION FINDINGS:

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On 01/29/2026, Licensing Program Analyst (LPA) Jose Anguiano conducted an unannounced complaint visit regarding the allegation mentioned above and met with Administrator Maria Galvan.
Investigation consisted of the following: LPA interviews with 7 staff members (S1–S7), staff and resident roster, review of 3 resident files (R1–R3), and 6 face sheets (R1–R6) along with their physician’s reports. Three incident reports regarding residents who were hospitalized were reviewed along with internal logs, fire drill reports, staff in-service training records, training on when to call physicians, and orders from printouts. In-service trainings dated 10/13 to 10/16 were also reviewed and collected.
The investigation revealed the following: Regarding the allegation “Staff do not have adequate record keeping for the residents,” it is being alleged that residents’ records were incomplete.
Observations revealed: On 01/29/2026, LPA observed that resident face sheets and files were incomplete, missing essential information such as emergency contacts, diagnoses, and other required documentation.
Please see report continuation on (LIC9099C)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026

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 11-AS-20260126231538

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: 01/29/2026

NARRATIVE

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These gaps were noted across multiple records reviewed during the visit.
Interviews with staff (S1–S7) were conducted and revealed the following:
(S1) stated that while resident records such as face sheets and medication logs exist, the current system is disorganized and lacks standardization. S1 acknowledged dissatisfaction with the existing filing system and reported that a new process is being implemented to improve accessibility and completeness. (S2–S3) confirmed they primarily handle record printing during emergencies, while (S4–S7) indicated they have limited access to records, which could delay response times during critical situations.
Records review revealed the following: Face sheets for R1–R6 included basic information such as date of birth, name, gender, allergies, and primary care provider (PCP); however, they lacked essential details including personal information, diagnoses, diet, social security number, insurance information, emergency contacts, and provider details. All six face sheets were inconsistent and incomplete. Additionally, file reviews for R1–R3 showed further deficiencies, with R1’s pre-placement appraisal not completed and R2 and R3 missing required documentation.
Based on the evidence gathered, records reviewed, observations, and interviews conducted, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be SUBSTANTIATED. This is a violation of California Code of Regulations, Title 22, Division 6, Chapter 8. A citation is being issued on the attached (LIC-9099D).

An exit interview, a copy of this report, and appeal rights were provided to the Administrator.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260126231538

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/29/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/26/2026 Section Cited CCR 87468.1(a)(2)	1 2 3 4 5 6 7	87468.1 (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee agreed to submit a plan by the due date to ensure all resident records are complete and consistent and submitted to LPA: at Jose.Anguiano@dss.ca.gov
	8 9 10 11 12 13 14	The licensee did not ensure residents are accorded safe and healthful accommodations, as record review and interviews revealed incomplete resident face sheets and records for R1-R6 and that staff S1 was unable to provide complete health information to first responders, posing a potential health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026

LIC9099 (FAS) - (06/04)

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