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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 236804090
Report Date: 12/27/2024
Date Signed: 12/27/2024 12:59:07 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
12/13/2024 and conducted by Evaluator Christopher Arnhold
COMPLAINT CONTROL NUMBER: 21-AS-20241213170036
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: 3DATE:
12/27/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Isaac RolleTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff did not administering medication as ordered
INVESTIGATION FINDINGS:
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At approximately 12:00PM, 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, toured the building and reviewed records. Based on interviews conducted, medication was delivered to the facility and received by a staff member. The medication was placed into the secure storage but the staff did not let anyone else know it had arrived. Resident did not receive the two days of medication due to this mistake. Upon further investigation, the medication was located and resident began receiving as ordered.

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: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2024
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 4
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
12/13/2024 and conducted by Evaluator Christopher Arnhold
COMPLAINT CONTROL NUMBER: 21-AS-20241213170036

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: 3DATE:
12/27/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Isaac RolleTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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9
Staff did not report an issue with the sewer system
Facility has not had a working telephone in 2 weeks
INVESTIGATION FINDINGS:
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At approximately 12:00PM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to open an investigation into the above allegations. LPA met with Administrator Isaac Rolle, toured the building and reviewed records. Based on records reviewed and interviews conducted, facility did have a problem with their sewer system and contacted a plumber. The issue was only with one bathroom and the plumber was able to correct the issue the same day. No residents went without bathroom access during this time frame. Based on interviews conducted and records reviewed, the facility telephone service was not working properly and AT&T was contacted on 12/13/2024. The telephone was working but there was an issue hearing and being heard. A service technician arrived the same day to correct the issue. LPA received documents regarding the sewer repair and telephone repair.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 21-AS-20241213170036
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: 12/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/28/2024
Section Cited
CCR
87465(a)(4)
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87465 Incidental Medical and Dental Care:(4) The licensee shall assist residents with self administered medications as needed. This requirement is not met as evidenced by: Based on interviews conducted, resident medication was delivered but was not started for two days. This poses an immediate
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Licensee to ensure residents receive medications as ordered. Staff responsible for receiving the medication and not alerting anyone else, as facility procedure states, was terminated. All staff received refresher training on medication procedures. POC Cleared during visit.
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Health risk to residents in care.
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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: 12/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4