374605052-6-25-2026-08-AS-APAO-DWA8C3-20260723222314

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374605052
Report Date: 06/25/2026
Date Signed: 06/25/2026 03:37:33 PM

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
06/15/2026 and conducted by Evaluator Arian Golbakhsh

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20260615160516

FACILITY NAME:	SHADOW RIDGE SENIOR LIVING		FACILITY NUMBER:	374605052
ADMINISTRATOR:	BLOOM, CHARLES		FACILITY TYPE:	740
ADDRESS:	1440 S MELROSE DRIVE		TELEPHONE:	(760) 806-3600
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92056
CAPACITY:	160	CENSUS: 69	DATE:	06/25/2026
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Executive Director Charles Bloom		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Facility elevators not maintained in good repair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced visit to conduct a complaint investigation and delivered findings regarding the above mentioned allegation. LPA was welcomed by, identified themselves to, and discussed the purpose of their visit to Executive Director Charles Bloom. Note, LPA did step out for lunch from 12:30-1:30pm.

On 06/15/2026, the Department received a complaint where it was alleged that the two (2) facility elevators have been alternating being out of order since May, and at one point, both had been out of order at the same time, raising concern for non-ambulatory residents on the second floor. The Department’s investigation consisted of an unannounced facility visit, records review, and interviews with staff, residents, and outside sources.

[Continued on LIC 9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2026

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-20260615160516

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: SHADOW RIDGE SENIOR LIVING	FACILITY NUMBER: 374605052
	VISIT DATE: 06/25/2026

NARRATIVE

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[Continued from LIC 9099]

LPA conducted a brief tour of the facility and observed one operational elevator and one that was out of order. The non-operational elevator had appropriate signage to indicate it was out of order in addition to caution tape and an orange cone. LPA also observed a stairchair present in a stairwell inspected. Review of the facility's resident roster revealed that at least thirteen (13) residents on the second floor required some form of ambulation assistance, such as being wheelchair bound or requiring staff assistance for ambulation.

It is worth indicating that the facility underwent a change in ownership officiated by the Department in mid-May 2026. Per an interview with administrative staff, one elevator broke down around March 2026 and the other around April 2026, revealing that the elevator breakdowns occurred under management by the former Licensee. Per the staff member, the second elevator broke down while the first was still non-operational (waiting for a special part) and so both elevators were down for a period of less than a day and a technician was able to repair one elevator. It was also revealed during the interview that as the new Licensee/change of property ownership was being processed, it took time to determine which party (new/current Licensee, former Licensee, or former property owner) was responsible for the elevator repair payment. File review of work orders for the two elevators from an elevator repair company, dated 5/28/26, detailed the work and costs necessary to repair the two elevators. Date of acceptance by the facility for the work needed was listed as 6/11/26. Review of payment receipts submitted by the facility to the repair company were dated for 6/15/26 and 6/16/26.

An outside source interview with the elevator repair company corroborated the few hours of time where both elevators were down until one was repaired. It was also revealed the facility initiated proactive repair work to prevent such an issue from occurring in the future. Interviews with multiple staff members also corroborated that only a few hours had passed with both elevators down, with one mentioning that staff began conducting room checks, staff accompanied residents up and down stairs for safety, and staff utilized stairchairs for non-ambulatory residents.

[Continued on LIC 9099-C]

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2026

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20260615160516

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: SHADOW RIDGE SENIOR LIVING	FACILITY NUMBER: 374605052
	VISIT DATE: 06/25/2026

NARRATIVE

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[Continued from LIC 9099-C]

Interviews with residents and additional outside sources did not reveal any concerns about the elevators. One shared that the facility communicated that they were waiting on parts to repair the elevator.

The facility had demonstrated that it was aware of the work needed for the elevators' repair and has taken timely action to do so, especially considering the complexity of the repair process, such as assessment of the issues, payment processing, city permitting, etc..

Based on interviews and records review, while the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred – therefore the allegation has been determined to be UNSUBSTANTIATED. An exit interview was conducted with Executive Director Bloom to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2026

LIC9099 (FAS) - (06/04)

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