374605052-7-30-2026-08-AS-SMAZ-DWQU5S-20260807151709

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374605052
Report Date: 07/30/2026
Date Signed: 07/30/2026 01:00:01 PM

Unfounded

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
07/27/2026 and conducted by Evaluator Nacole Patterson

COMPLAINT CONTROL NUMBER: 08-AS-20260727160359

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: 73	DATE:	07/30/2026
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Executive Director Charles Bloom		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Personal Rights
Personal Rights
Staff did not observe changes in residents health condition
Staff did not communicate changes with resident's responsible person
Staff did not ensure medications were dispensed as prescribed
Staff did not ensure residents records were properly maintained
Staff did not assist resident with toileting needs
Staff did not provide copies of records to residents responsible party

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to initiate a complaint investigation regarding the above-mentioned allegations. LPA identified themselves and met with Executive Director Charles Bloom, to discuss the purpose of the visit and elements of the complaint.

During the visit it was discovered that the resident in question lived at this location under previous ownership and under a different facility number. No records were found to show that the resident lived at this facility under the current facility number and ownership. The investigation has now been opened under the correct facility number.

An exit interview was conducted with Executive Director Charles Bloom. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided and their signature on this report confirms receipt of the Licensee Rights.

Unfounded

Estimated Days of Completion: 0

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Nacole Patterson
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026

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 1