374604143-1-23-2021-08-AS-DPOL-BXS3KU-20210130171943

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604143
Report Date: 01/23/2021
Date Signed: 01/23/2021 09:37:32 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/04/2020 and conducted by Evaluator Jonathan C Pineda

COMPLAINT CONTROL NUMBER: 08-AS-20200604110036

FACILITY NAME:	OCEAN HILLS ASSISTED LIVING & MEMORY CARE		FACILITY NUMBER:	374604143
ADMINISTRATOR:	KURT NORDEN		FACILITY TYPE:	740
ADDRESS:	4500 CANNON RD		TELEPHONE:	(619) 865-2614
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92056
CAPACITY:	140	CENSUS: 82	DATE:	01/23/2021
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Sheryl Johnston, Executive Director		TIME COMPLETED:	09:36 AM

ALLEGATION(S):

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Facility did not honor admission agreement
The facility is not providing a resident with comfortable accommodations
The facility does not offer variety of food specific to a resident’s prescribed diet

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jonathan Pineda conducted an unannounced complaint tele-visit to deliver findings on the above allegations. LPA identified himself and stated the purpose of the visit. LPA spoke with Sheryl Johnston, Executive Director.

The Department's investigation consisted of a tour of the facility, observations, interviews, and a review of records.
It was alleged that facility staff did not honor admission agreement. Investigation revealed that Resident 1, R1 (See Confidential Names List) spoke to facility Executive Director, S1 and requested to vacate their room (#220) in January 2020 (unknow date). Interview revealed that S1 approved R1’s request if R1 removed all of their belongings from room #220. After deliberation, R1 decided to keep the room. On June 3, 2020, R1 advised S1 that they were not going to pay their full rent for June 2020. R1 emptied all belongings from room #220. S1 advised R1 that the facility would get them a revised billing statement. R1’s monthly fee for room #220 and #221 is $7,300 a month.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (610) 301-9770
LICENSING EVALUATOR NAME: Jonathan C Pineda	TELEPHONE: (619) 481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2021

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-20200604110036

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: OCEAN HILLS ASSISTED LIVING & MEMORY CARE	FACILITY NUMBER: 374604143
	VISIT DATE: 01/23/2021

NARRATIVE

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The facility gave R1 a revised statement that credits her $3,100 for room #220 and credits R1 in the amount of $2,200 that R1 had originally paid on June 3, 2020. There is a remaining balance of $2,000 owed for room #221.

It was alleged that facility is not providing a resident with comfortable accommodations. Interview with R1 revealed that there is constant construction around the building and the noise makes their accommodations very uncomfortable. R1 stated that trucks are very loud and arrive at the property very early in the morning. Interview with Administrator revealed there has always been full disclosure of the “Phase Two" building of an Independent Living Community behind the facility to all persons moving in. Marketing informs residents upon inquiry of Phase Two. R1 was advised that the facility has a permit for the grating of the land and that they were following all the rules as set on the permit (work to begin at 7 AM). Administrator has contacted the construction company and requested working to not begin until 8 AM to avoid disturbing residents. On May 11th, 2020, R1 was offered a "sleeping room" on the other side of the building. R1 chose room 109. Facility staff immediately put a bed, bedside table, chair and lamp in the room for R1. After one week, R1 returned the keys and advised S1 that they used the room once and didn't want to move their things back and forth. S1 offered to move R1’s things, but R1 said no. S1 offered a different room that was closer to R1’s unit, and R1 said no.

It was alleged that facility does not offer variety of food specific to a resident’s prescribed diet. R1 advised during interview that all their meals are made with heavy creams and meats are infused with salts. R1 advised that much of the foods are fried and these foods are not specific to their diet. R1 stated the facility has healthy alternatives however, it is not to their liking. Interview with S2 revealed facility is always willing to accommodate R1’s dietary needs and requests. R1 was advised by S1, S2, and facility cooks that they will make any dish to R1’s liking. S2 advised that no matter what is on the menu for the day, staff will prepare it to R1’s specifications. This includes snacks, fruit, veggies, and anything R1 needs.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (610) 301-9770
LICENSING EVALUATOR NAME: Jonathan C Pineda	TELEPHONE: (619) 481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2021

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20200604110036

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: OCEAN HILLS ASSISTED LIVING & MEMORY CARE	FACILITY NUMBER: 374604143
	VISIT DATE: 01/23/2021

NARRATIVE

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LPA observed R1’s Physician report which states a “regular diet” as designated by their physician. LPA observed menu and food supply to have a good variety of several different proteins, vegetables and desserts.

The Department investigated the allegations that staff did not honor admission agreement, facility is not providing a resident with comfortable accommodations, and facility does not offer variety of food specific to a resident’s prescribed diet.

Based on observations, a review of records, and interviews, it is determined that the allegations are UNSUBSTANTIATED. There is not a preponderance of the evidence to prove the allegations occurred.

An exit interview was conducted with Sheryl Johnston, Executive Director. A copy of this report LIC 9099 along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Sheryl via email. An electronic email read receipt confirms the documents were received.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (610) 301-9770
LICENSING EVALUATOR NAME: Jonathan C Pineda	TELEPHONE: (619) 481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2021

LIC9099 (FAS) - (06/04)

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