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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604802
Report Date: 10/07/2025
Date Signed: 10/07/2025 11:17:21 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
12/18/2024 and conducted by Evaluator Grace Donato
COMPLAINT CONTROL NUMBER: 08-AS-20241218141448
FACILITY NAME:SUNRISE OF OCEANSIDEFACILITY NUMBER:
374604802
ADMINISTRATOR:MELON RIVERAFACILITY TYPE:
740
ADDRESS:4845 MESA DRTELEPHONE:
(408) 962-2982
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY:136CENSUS: DATE:
10/07/2025
UNANNOUNCEDTIME BEGAN:
11:01 AM
MET WITH:Kimberly MalaspinaTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Lack of supervision resulted in resident on resident abuse with serious injury
INVESTIGATION FINDINGS:
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On 10/7/2025, LPA Grace Donato conducted a telephone interview with the facility to deliver findings. LPA spoke with Administrator, Kimberly Malaspina and explained the purpose of the call.

Regarding the allegation of Lack of supervision resulted in resident on resident abuse with serious injury, Reporting Party (RP) stated that a resident (R1) took an unwitnessed fall that led to R1s hip breaking. RP mentioned that another resident (R2) pushed R1.

During the investigation, staff members were interviewed, and records were reviewed.

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Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
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 2
Control Number 08-AS-20241218141448
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: SUNRISE OF OCEANSIDE
FACILITY NUMBER: 374604802
VISIT DATE: 10/07/2025
NARRATIVE
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Staff that were interviewed were present in the memory care on 12/17/2024 during the AM shift. While providing assistance to another resident, S1 saw R1 on the ground in the adjoining living room. S1 got additional assistance from S2 who was also assisting with the other resident. S2 asked resident R1 what happened. According to S2, R1 said, “R2 pushed me,” and pointed to R2. Both staff were the only direct care staff in the area at the time and acknowledged R2 was by R1 in the living room. There is no video surveillance inside the facility. R1 was assessed by facility staff. Emergency services were called and transported R1 to the hospital for evaluation.

For the records that were reviewed, both R1 and R2 have neuro cognitive disorders. R1 was noted as independent with mobility and transferring. R2 is noted as not having any inappropriate or aggressive behavior.

While R1 sustained an injury while in care, there is no evidence that either R2 had inappropriate or aggressive behavior, and that additional supervision was needed to prevent a resident-on-resident altercation. There is no corroborating evidence that a lack of supervision resulted in R1 being pushed by R2 resulting in injury.

Based on interviews, observations and records review, the department has determined that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Report is reviewed and copy is provided.

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SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
LIC9099 (FAS) - (06/04)
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