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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604143
Report Date: 03/17/2025
Date Signed: 03/17/2025 02:38:55 PM

Document Has Been Signed on 03/17/2025 02:38 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:OCEAN HILLS ASSISTED LIVING & MEMORY CAREFACILITY NUMBER:
374604143
ADMINISTRATOR/
DIRECTOR:		JOHNSTON, SHERYLFACILITY TYPE:
740
ADDRESS:4500 CANNON RDTELEPHONE:
(760) 295-8515
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY: 123CENSUS: 108DATE:
03/17/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Executive Director Sheryl JohnstonTIME VISIT/
INSPECTION COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced case management visit to conduct follow up regarding an incident report. LPA was greeted by, identified herself to, and explained the purpose of the visit with Executive Director Sheryl Johnston.

On 3/14/2025, the Department received an incident report from the facility that described that on 3/5/2025, Resident 1 (R1) complained of pain during the overnight shift. [Executive Director was provided with an LIC811 Confidential Names list to identify R1] Facility staff offered R1 PRN pain medication, which R1 did not want, resulting in staff calling emergency services. R1 was transported to the hospital where R1 received medical attention and was diagnosed with multiple health conditions, including two injuries. R1 returned to the facility on 3/10/2025.

During today’s visit, LPA conducted a health and safety check, observed residents in care, and reviewed and obtained copies of facility records.

No deficiencies were cited on today’s date and no immediate health or safety concerns were observed. An exit interview was conducted with Executive Director Sheryl Johnston, whose signature below confirms receipt of a copy of this report, the LIC811, and the Licensee Appeal Rights (LIC9058 3/22).
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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