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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320433
Report Date: 09/11/2025
Date Signed: 09/11/2025 05:12:38 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/05/2025 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 11-AS-20250905120240
FACILITY NAME:OCEANVIEW LIVING OF SAN PEDROFACILITY NUMBER:
198320433
ADMINISTRATOR:SABINA NAYBERGFACILITY TYPE:
740
ADDRESS:2100 SOUTH WESTERN AVENUETELEPHONE:
(310) 548-0625
CITY:SAN PEDROSTATE: CAZIP CODE:
90732
CAPACITY:86CENSUS: 52DATE:
09/11/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator - Gloriella JaraTIME COMPLETED:
05:20 PM
ALLEGATION(S):
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Facility does not ensure that residents' dietary needs are met.
Food provided to residents lacks nutritional value.
Residents are not treated with dignity and respect.
INVESTIGATION FINDINGS:
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On 09/11/2025, Licensing Program Analyst (LPA) Socorro Leandro conducted a complaint investigation regarding the allegations listed above. LPA met with the Administrator, Gloriella Jara and the purpose of the visit was explained. The LPA was allowed entry to the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
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 5
Control Number 11-AS-20250905120240
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: OCEANVIEW LIVING OF SAN PEDRO
FACILITY NUMBER: 198320433
VISIT DATE: 09/11/2025
NARRATIVE
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The investigation consisted of the following:

On 08/20/2025, interviews were conducted, facility tour was conducted, and records were reviewed. Interviews conducted consisted of Resident 1 (R1) to Resident 8 (R8) and Staff 1 (S1) to Staff 6 (S6) were interviewed. The facility tour consisted of the kitchen and dining room. Facility records reviewed consisted of Personnel Report dated 09/09/2025, Register of Facility Residents dated 09/08/2025; Staff Training dated 08/27/2025; Weekly Menus from 08/31/2025 to 10/11/2025; Resident Meeting Minutes from July to August 2025; Daily Kitchen Checklist from 06/02/2025 to 09/07/2025; Resident Diabetic List; Resident List of Food Preferences; Resident List of Diets / Restrictions. Resident 1’s records reviewed consisted of Admission Agreement dated 06/24/2025; Physicians Report dated 06/02/2025; Preplacement Appraisal Information dated 06/28/2025; Personal Rights dated 06/24/2025; Identification And Emergency Information dated 06/24/2025.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20250905120240
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: OCEANVIEW LIVING OF SAN PEDRO
FACILITY NUMBER: 198320433
VISIT DATE: 09/11/2025
NARRATIVE
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The investigation revealed the following:

Allegation: “Facility does not ensure that residents' dietary needs are met”, it is being alleged that the facility does not provide residents with their special diet, thus not meeting residents’ dietary needs. Interviews conducted with R1 to R8 revealed the following: 7 out of 8 residents denied the allegation; 1 out of 8 residents agreed with the allegation. Interviews conducted with S1 to S6 revealed the following: 6 out of 6 staff denied the allegation. Observations on 09/11/2025 revealed the following: the kitchen entrance has several postings which include Resident Diabetic List, Resident List of Food Preferences, and Resident List of Diets / Restrictions. At around 11:32 AM lunch time was observed, and it demonstrated that some residents receive special diet meals and all residents receive well balanced meals; the dining room has a buffet style set up where residents are able to choose the foods they would like to eat and request for seconds. Over 10 pictures were observed of well-balanced specialized diet meals. Records of Weekly Menus from 08/31/2025 to 10/11/2025 revealed the following: the menus offer well balanced meals with a variety of dishes with 3 to 4 options that are vegetarian options. Based on the department’s interviews, observations, and records reviewed this allegation is unsubstantiated. Unsubstantiated: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20250905120240
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: OCEANVIEW LIVING OF SAN PEDRO
FACILITY NUMBER: 198320433
VISIT DATE: 09/11/2025
NARRATIVE
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Allegation: “Food provided to residents lacks nutritional value”, it is being alleged that the facility food is not of good quality. Interviews conducted with R1 to R8 revealed the following: 7 out of 8 residents denied the allegation; 1 out of 8 residents agreed with the allegation. Interviews conducted with S1 to S6 revealed the following: 6 out of 6 staff denied the allegation. Observations on 09/11/2025 revealed the following: the kitchen freezers, fridges, and dry goods storage room had good quality meats, dairy products, vegetables, fruits, grains, etc. The lunch provided to residents was of good quality food. Records reviewed of Daily Kitchen Checklist from 06/02/2025 to 09/07/2025 revealed the following: kitchen staff are maintaining areas clean and maintaining food in good quality. Based on the department’s interviews, observations, and records reviewed this allegation is unsubstantiated. Unsubstantiated: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20250905120240
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: OCEANVIEW LIVING OF SAN PEDRO
FACILITY NUMBER: 198320433
VISIT DATE: 09/11/2025
NARRATIVE
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Allegation: “Residents are not treated with dignity and respect.” Interviews conducted with R2 to R8 revealed the following: 7 out of 7 residents denied the allegation. Interviews conducted with S1 to S6 revealed the following: 6 out of 6 staff denied the allegation. Observations on 09/11/2025 revealed the following: residents were observed being treated with dignity and respect. Records reviewed of Staff Training dated 08/27/2025 revealed the following: staff were trained in Resident Personal Rights. Based on the department’s interviews, observations, and records reviewed this allegation is unsubstantiated. Unsubstantiated: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

No citations were provided.

An exit interview was conducted and a copy of this report was provided to Administrator, Gloriella Jara.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5