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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602252
Report Date: 05/08/2026
Date Signed: 05/08/2026 10:14:05 AM

Substantiated


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
12/05/2023 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20231205174438
FACILITY NAME:OCEANSIDE REST HOME IIFACILITY NUMBER:
374602252
ADMINISTRATOR:SIERA NAVASAKFACILITY TYPE:
740
ADDRESS:15 SHASTA COURTTELEPHONE:
(760) 722-8503
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:6CENSUS: 5DATE:
05/08/2026
UNANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:Sierra Navasak, AdministratorTIME COMPLETED:
10:20 AM
ALLEGATION(S):
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Lack of supervision resulted in resident on resident altercation.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to close out a complaint on the above-mentioned allegation. LPA gained access to the facility, identified herself, and met with Sierra Navasak, Administrator to discuss the purpose of the visit.

LPA conducted conducted a tour of the facility, and conducted interviewes. It was alleged that lack of supervision resulted in resident on resident altercation. Interviews revealed that staff there was an incident with two residents on or round 12/04/2023. Interviews revealed that Resident 1 (R1) poked R2 with a fork while at the dinner table. Interviews revealed that while the incident took place there was only one staff at the time and they were in the kitchen. Interviews revealed that the staff cannot see the table or residents from the kitchen but they could hear. Interviews revealed another resident took the fork away from R1 while at the table. Interviews revealed that on the day of the incident 2 staff were off which led the facility to only have 1 staff at the time. Interviews revealed that R1 did not go to the hospital for any injury.

Based on the evidence obtained from interviews, the complaint allegation is substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met.

A deficiency is cited per Title 22 California Code of Regulation on the 9099 D page. An exit interview was conducted with Sierra Navasak, Administrator and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026
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 2
Control Number 08-AS-20231205174438
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: OCEANSIDE REST HOME II
FACILITY NUMBER: 374602252
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/21/2026
Section Cited
CCR
87468.2(a)(4)
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Additional Personal Rights ... (a)…residents… shall have... the following personal rights: (4) To care, supervision, and services that meet their... needs and are delivered by staff that are sufficient in...qualifications, and competency to meet their needs.
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The administrator agreed to attend training along with staff regarding topics of care and supervision. POC due to CCL by 05/21/2026
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This requirement was not met as evidenced by:
Based on interviews and records review the licensee did not provide care and supervision to 1 out of 6 [R1] residents, which posed an immediate health, safety, and personal rights risk 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: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026
LIC9099 (FAS) - (06/04)
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