374604533-10-28-2025-08-AS-SJAB-DMVTQE-20251028145550

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604533
Report Date: 09/30/2025
Date Signed: 10/28/2025 09:05:37 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
10/19/2023 and conducted by Evaluator Amy Domingo

COMPLAINT CONTROL NUMBER: 08-AS-20231019091938

FACILITY NAME:	SANTIANNA OAKMONT SIGNATURE LIVING		FACILITY NUMBER:	374604533
ADMINISTRATOR:	EL RABAA, SAM		FACILITY TYPE:	740
ADDRESS:	2560 FARADAY AVE		TELEPHONE:	(442) 325-8090
CITY:	CARLSBAD	STATE: CA	ZIP CODE:	92010
CAPACITY:	226	CENSUS:	DATE:	09/30/2025
		UNANNOUNCED	TIME BEGAN:	01:23 PM
MET WITH:	Tammie Sampedro Executive Director		TIME COMPLETED:	01:24 PM

ALLEGATION(S):

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Staff failed to report the elopement incident
Staff have not had the required fire and earthquake drills
Registry staff untrained
Neglect of personal care
Staff are unaware of the census for safety
Service plans not updated for the resident with changes in conditions

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver a finding regarding the above prior complaint allegations. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Executive Director Tammie Sampedro.

CCLD’s investigation involved unannounced facility visits, welfare checks, and review of facility care and medical records. The Department also interviewed relevant staff, clients, and outside sources.

On 10/19/23, it was alleged that the Staff failed to report the elopement incident. LPA Domingo interviewed staff at the facility, and there has not been any elopement incident to report.

LPA Domingo reviewed facility records, and there have not been any recent elopements at the facility.
Interviews with outside sources revealed no knowledge of any elopements of residents at the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025

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 4

Control Number 08-AS-20231019091938

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: SANTIANNA OAKMONT SIGNATURE LIVING	FACILITY NUMBER: 374604533
	VISIT DATE: 09/30/2025

NARRATIVE

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LIC9099C 2 of 4

On 10/19/23, it was alleged that the Staff had not had the required fire and earthquake drills. LPA Domingo interviewed staff at the facility, and the staff verified that they have regular fire drills and earthquake drills. All the staff interviewed had been trained during their orientation on fire drills and earthquake drills.

LPA Domingo interviewed residents, and they stated that they have observed regular emergency fire and earthquake drills. According to outside sources, they stated that they recalled emergency service drills that the facility regularly conducted. LPA reviewed the facility's records, and the facility has documentation of regularly conducted fire and natural disaster drills.

On 10/19/23, it was alleged that Registry staff were untrained. Interviews with staff revealed no concerns with registry staff and how they perform their responsibilities Interviews with residents revealed no concerns with the registry staff. Interviews with outside sources revealed no concerns with regard to registry staff and their work performance. Records reviewed revealed that all registry staff are trained by the company they work for, and additional training was conducted by the facility before working at the facility.

On 10/19/23, it was alleged neglect of personal care.LPA Domingo interviewed staff, and all residents receive assistance with bathing, and they are trained to monitor hygiene and report any concerns. Staff are trained to document any resident refusal of care with bathing, grooming, and hygiene issues.

LPA interviewed residents, and they stated that the staff provided grooming and hygiene care as needed.
LPA interviewed outside sources, and they stated that the staff do their best to assist their loved ones with bathing, grooming and daily hygiene care.

Records reviewed provided documentation of resident refusals of baths, grooming, and hygiene care, and the facility Wellness director will investigate the reasons for refusing care and update the resident's care plan, and the MD will be notified of any changes in the resident's behaviors.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 08-AS-20231019091938

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: SANTIANNA OAKMONT SIGNATURE LIVING	FACILITY NUMBER: 374604533
	VISIT DATE: 09/30/2025

NARRATIVE

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LIC9099 3 of 4

On 10/19/23, it was alleged that staff are unaware of the census for safety. The facility maintains a daily census log, updated at the beginning of each shift and during shift changes. The log includes residents who are on-site, temporarily off-site (e.g., hospital, family visits), and newly admitted or discharged. Emergency drill records show that staff accounted for all residents during recent fire and earthquake drills.

An interview with S1 described the facility’s census tracking system and confirmed that staff are trained to update and review the census log each shift. S2 demonstrated knowledge of the current census and explained the process for tracking residents during outings and emergencies. S3 accurately identified the number of residents present and those temporarily off-site at the time of the visit.

R2 and R3 reported feeling safe and stated that the staff are attentive and aware of who is present in the facility. No residents expressed concerns about staff awareness or supervision. Outside source 2 confirmed that the facility communicates when the resident leaves or returns and expressed confidence in the staff's attentiveness. LPA Domingo observed staff using a census board and a sign-in and sign-out sheet for residents leaving the facility. There were no discrepancies noted between the observed resident count and the documented census.

On 10/19/23, it was alleged that service plans had not been updated for the resident with changes in conditions. Records reviewed revealed that the appraisal/needs and service plans were updated for three (3) residents who had a change of condition. The MD was updated, the responsible party was updated, and a care conference was scheduled to review the increased care needed.

LPA Domingo interviewed S1 and confirmed that the resident's condition change was documented and the service plan was updated. S2 demonstrated knowledge of the resident's updated care needs and described the changes implemented in daily care routines. S3 confirmed that medication administration protocols were adjusted in accordance with the updated plan.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 08-AS-20231019091938

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: SANTIANNA OAKMONT SIGNATURE LIVING	FACILITY NUMBER: 374604533
	VISIT DATE: 09/30/2025

NARRATIVE

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LIC9099C 4 of 4

R2 stated they received additional assistance after returning from the hospital and felt their needs were being met. OS2 confirmed they were notified of any change in condition and received a copy of the updated service plan during the care conference.

The Department has investigated a complaint with the above allegations. The Department has found that although the allegations may have occurred or be valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur; therefore, the allegations are unsubstantiated. An exit interview was conducted with Executive Director, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025

LIC9099 (FAS) - (06/04)

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