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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 236804090
Report Date: 08/12/2024
Date Signed: 08/12/2024 12:10:55 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/30/2024 and conducted by Evaluator Christopher Arnhold
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20240430145056
FACILITY NAME:OCEANFRONT CARE HOME LLCFACILITY NUMBER:
236804090
ADMINISTRATOR:NGAIMA, MAMAFACILITY TYPE:
740
ADDRESS:1370 NAVARRO BLUFF ROADTELEPHONE:
(707) 877-1698
CITY:ALBIONSTATE: CAZIP CODE:
95410
CAPACITY:6CENSUS: 4DATE:
08/12/2024
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Isaac RolleTIME COMPLETED:
12:25 PM
ALLEGATION(S):
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Facility staff are not assisting resident with transfers
INVESTIGATION FINDINGS:
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At approximately 10:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegation. LPA met with Administrator Isaac Rolle and reviewed records. Based on a review of records and interviews conducted, facility staff did not assist resident in transfers out of bed. Staff interviewed stated they were informed to not move resident into the wheelchair, but could not provide documentation of such an order. LPA observed the physician report notes the use of a hoyer lift for transfers. Pre Admission appraisal shows residents desire to get out of bed into the wheel chair. Resident utilized an oversized wheel chair that did not fit easily through the doorway to the bedroom. Resident was listed as Non-Ambulatory. Based on the Departments investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Administrator and Appeal rights were given.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2024
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 2
Control Number 21-AS-20240430145056
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: OCEANFRONT CARE HOME LLC
FACILITY NUMBER: 236804090
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/13/2024
Section Cited
CCR
87464(d)
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Basic Services:A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs...This
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Administrator reviewed Basic Services regulation and has provided LPA self certifiation of understanding. Resident no longer resides at facility.
POC cleared at time of visit.
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requirement is not met as evidenced by: Based on records reviewed and interviews conducted, staff did not assist resident in transferring. This poses an immediate Health, Safety or Personal rights risk to residents.
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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: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2