374601952-10-14-2024-08-AS-JLOT-DA9SS8-20241021140732

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374601952
Report Date: 10/14/2024
Date Signed: 10/14/2024 01:54:03 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/10/2024 and conducted by Evaluator Rebecca A Ruiz

COMPLAINT CONTROL NUMBER: 08-AS-20240910161144

FACILITY NAME:	BROOKDALE OCEANSIDE		FACILITY NUMBER:	374601952
ADMINISTRATOR:	CANDI LAIRD		FACILITY TYPE:	740
ADDRESS:	3524 LAKE BLVD		TELEPHONE:	(760) 945-1811
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92056
CAPACITY:	186	CENSUS: 97	DATE:	10/14/2024
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Executive Director Candi Laird		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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False Claims

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Executive Director Candi Laird.

The Department’s investigation consisted of interviews with staff and outside sources, records review, and a tour of the facility. It was alleged that the licensee engaged in false claims, specifically claiming that Resident 1 (R1) had passed away, however, R1 was alive. Interviews with staff and review of R1’s assessment records dated 2023 revealed that R1 had a diagnosis of major cognitive impairment, was confused and disoriented, and was unable to follow instructions or make their needs known.

Continued on LIC9099-C page...

Unfounded

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2024

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 08-AS-20240910161144

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: BROOKDALE OCEANSIDE	FACILITY NUMBER: 374601952
	VISIT DATE: 10/14/2024

NARRATIVE

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Interviews with staff revealed that R1 resided in the facility’s memory care and began receiving hospice services on 10/26/2023. Interviews with staff revealed that R1 was discharged from the facility on 1/19/2024 and transferred to a facility that provided a higher level of care. Interviews with staff and outside sources stated that R1 passed away on 1/27/2024 while at the higher level of care facility, which was confirmed by the facility’s death report. Review of R1’s county issued certificate of death also confirmed R1’s date of death and location at time of death. Interviews with outside sources corroborated the timeline provided by the facility. Interviews with staff and outside sources and review of R1’s certificate of death did not reveal any evidence that the licensee, facility management, or facility staff made any false allegations regarding R1’s status or death.

The Department has investigated the above-mentioned allegation and based on interviews and records review, it was determined that the complaint allegation is Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted with Executive Director Candi Laird, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2024

LIC9099 (FAS) - (06/04)

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