374604411-5-21-2026-08-AS-LTEZ-DUFVQS-20260526163850

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604411
Report Date: 05/21/2026
Date Signed: 05/21/2026 09:26:59 AM

Unsubstantiated

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
04/08/2026 and conducted by Evaluator Ramin Hashemi

COMPLAINT CONTROL NUMBER: 08-AS-20260408113608

FACILITY NAME:	LA MAREA SENIOR LIVING		FACILITY NUMBER:	374604411
ADMINISTRATOR:	MATTHEW RYAN		FACILITY TYPE:	740
ADDRESS:	5592 EL CAMINO REAL		TELEPHONE:	(442) 325-3510
CITY:	CARLSBAD	STATE: CA	ZIP CODE:	92008
CAPACITY:	125	CENSUS: 109	DATE:	05/21/2026
		UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Executive DIrector Mariano Perez Business Office Director Donnie Johnson		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Questionable death
Staff did not ensure medications were dispensed as prescribed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ramin Hashemi conducted an unannounced visit to deliver findings regarding the above complaint allegations. LPA introduced themselves and disclosed the purpose of the visit to Executive DIrector Mariano Perez.

On 04/02/2026 it was alleged that the facility was responsible for a "Questionable Death." The Department’s investigation consisted of unannounced facility visits, interviews with facility staff, outside sources, and records review.

Regarding the allegation, "Questionable Death," it was alleged that a resident's cause of death was an overdose of over the counter brand decongestant Mucinex.

(Continued on LIC9099C, Page 2)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Ramin Hashemi
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026

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 3

Control Number 08-AS-20260408113608

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: LA MAREA SENIOR LIVING	FACILITY NUMBER: 374604411
	VISIT DATE: 05/21/2026

NARRATIVE

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(Continued from LIC9099, Page 1)

Interviews with outside sources confirmed that there was an investigation performed by California Department of Pubic Heath (CDPH) into the reporting parties allegations. Outside Source 1 (OS1) stated that the hospice provider Resident 1 (R1) was receiving treatment with was investigated by the CDPH and allegations with identical claims were found to be unsubstantiated based on the evidence of the investigations. Additionally, OS1 stated there was another investigation performed by a nurse investigator who included a review of the facility and found the claims were unsubstantiated as well. Outside Source 2 (OS2) told the LPA that "without evidence of significant overdose or allergic reaction, it would be difficult to establish a causal link between Guaifenesin (Mucinex) dosage and death in a 99-year-old resident."

Records Review revealed that the death certificate of R1 listed the cause of death as Organ Failure, with Cardiac Disease as a contributing factor. The circumstances noted do not indicate an unnatural or questionable death. This corroborates outside source interviews.

Based on interviews and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED.

On 04/02/2026 it was alleged that "Staff did not ensure medications were dispensed as prescribed" The Department’s investigation consisted of unannounced facility visits, interviews with facility staff, outside sources, and records review.

Regarding the allegation, "Staff did not ensure medications were dispensed as prescribed," it was alleged that facility staff did not follow the prescribed directions of administering decongestant Mucinex to R1.

Interviews with facility staff revealed that R1 was not taking the medication outside of the recommended dosage or outside of the attending physician's orders.

(Continued on LIC9099C, Page 3)

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Ramin Hashemi
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20260408113608

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: LA MAREA SENIOR LIVING	FACILITY NUMBER: 374604411
	VISIT DATE: 05/21/2026

NARRATIVE

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Interviews with outside sources confirmed that there was an investigation performed by CDPH into the reporting parties allegations. OS1 stated that the hospice provider R1 was receiving treatment with was investigated by the CDPH and allegations with identical claims were found to be unsubstantiated based on the evidence of the investigation. Additionally, OS1 stated there was another investigation performed by a nurse investigator who included a review of the facility and found the claims were unsubstantiated as well. According to Outside Source 2 (OS2), "Guaifenesin (Mucinex) at recommended doses is not known to cause organ failure or cardiac death. The FDA-approved labeling for Mucinex (guaifenesin alone) does not list cardiac disease as a contraindication, nor does it warn about organ failure or cardiac complications when used at recommended doses."

Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Executive DIrector Mariano Perez, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Ramin Hashemi
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026

LIC9099 (FAS) - (06/04)

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