Brookdale Oceanside.

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Executive Director Candi Laird. During today's visit, LPA reviewed facility records and observed residents in care. Due to time constraints, the annual inspection could not be completed and a return visit on a subsequent day is needed. No deficiencies were cited on today's date. An exit interview was conducted with Executive Director Candi Laird, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).

Review of R1’s admission agreement signed in August 2022 revealed that the facility issued monthly statements listing the itemized rate and service charges, or basic rate, which were due on the 1 st of every month. Interviews with an outside source, facility staff, and review of R1’s account history revealed that starting in approximately December 2023, R1 did not pay the full basic rate at the facility. Interviews with an outside source and facility management confirmed that R1 had depleted their finances and did not enough money to continue to pay the basic rate at the facility. Interviews revealed that when facility management became aware of R1’s financial issues in November 2023, facility management provided R1’s responsible party with contact information for alternative placement options and referral agencies. Additionally, multiple third party agencies assisted in trying to find alternative placement for R1. Those interviews with facility management and review of facility communication revealed that facility management also made phone calls to alternative placement options and referred any information to R1’s responsible party. Review of R1’s admission agreement signed August 2022 stated that the facility could issue an eviction notice to any residents who did not pay the basic service rate within ten days of the due date. On July 23, 2024, the facility issued a 30-day eviction notice to R1 for failure to pay from January 2024 to July 2024 and provided physical copies to R1 and their responsible party, which was confirmed via interviews. The eviction notice did state that R1 submitted partial payments in May 2024 and July 2024, however, there was still an outstanding balance as of the date of the eviction notice. Review of R1’s account history report confirmed the partial payments and outstanding balance. The eviction notice stated that if R1 was able to pay the entire outstanding balance prior to August 23, 2024, the facility would not move forward with eviction. The eviction was hand delivered to R1, which was confirmed via interviews and review of the affidavit of hand delivery document signed by R1, the facility's Executive Director, and a witness on 7/23/2024. R1’s responsible party was also mailed a copy of the eviction notice on 7/23/2024, which was confirmed via interview and signed affidavit of service by mail, signed by the Executive Director. Review of documents received by the Department revealed that the facility also submitted a copy of R1’s eviction notice to the Department on 7/24/2024 and the eviction notice did not lack any required language, resources, effective date, or any other regulatory requirements that would have made the eviction notice invalid. Continued on LIC9099-C page... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Review of Exhibit E of the Admission Agreement revealed that R1’s responsible party confirmed understanding that the facility was private pay and was unable to accept or retain residents who were eligible for Supplemental Security Income (SSI). Per interviews, R1’s responsible party made attempts to have R1 enrolled in the Assisted Living Waiver Program (ALWP), however, review of the ALWP website revealed that as of 3/12/2025, the facility was not listed as an ALWP participating facility. Interviews with an outside source revealed that R1 remained at the facility after the eviction’s effective date of August 23, 2024, which was confirmed by interviews with facility staff, outside sources, as well as visually confirmed by LPA Borunda during an onsite visit on 3/18/2025. Interviews with an outside source denied any concerns regarding the care that R1 received at the facility prior to or after the eviction notice being issued. Review of court records revealed that on 2/19/2025, the facility filed for an unlawful detainer with County of San Diego Superior Court against R1 for the unpaid balance and eviction. According to facility management, the unlawful detainer is pending with Superior Court as of 3/18/2025. The Department has investigated the above-mentioned allegation and based on interviews and records review, this allegation is deemed unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted with Executive Director Candi Laird, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Executive Director Candi Laird. During today's visit, LPA reviewed facility records and observed residents in care. Due to time constraints, the annual inspection could not be completed and a return visit on a subsequent day is needed. No deficiencies were cited on today's date. An exit interview was conducted with Executive Director Candi Laird, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).

Interviews with staff revealed that R1 resided in the facility’s memory care and began receiving hospice services on 10/26/2023. Interviews with staff revealed that R1 was discharged from the facility on 1/19/2024 and transferred to a facility that provided a higher level of care. Interviews with staff and outside sources stated that R1 passed away on 1/27/2024 while at the higher level of care facility, which was confirmed by the facility’s death report. Review of R1’s county issued certificate of death also confirmed R1’s date of death and location at time of death. Interviews with outside sources corroborated the timeline provided by the facility. Interviews with staff and outside sources and review of R1’s certificate of death did not reveal any evidence that the licensee, facility management, or facility staff made any false allegations regarding R1’s status or death. The Department has investigated the above-mentioned allegation and based on interviews and records review, it was determined that the complaint allegation is Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. An exit interview was conducted with Executive Director Candi Laird , whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).

Interviews with staff, R1, and outside sources revealed that R1 had been complaining about shoulder pain starting approximately in December 2021 and was receiving pain medication on an as needed basis. Communication logs revealed that R1’s physician ordered an X-ray for R1’s arm in January 2022, which discovered a fracture on R1’s arm. R1 made statements during interviews that R1 believed that the fracture was due to a childhood injury that R1 further aggravated during R1’s career. R1 denied having fallen at the facility, being mistreated by staff, being dropped during a transfer, or experiencing any incidents that might have caused the fracture. R1 made statements during interviews that R1 would have voiced any concerns or complaints regarding the treatment R1 received from facility staff and that R1 did not have any complaints or concerns regarding the facility staff. Interviews with staff and outside sources corroborated R1’s statements and denied being made aware of any complaints R1 had made about care provided by facility staff. Interviews with staff and outside sources revealed that R1 would transfer into a recliner by placing their arms behind their body and then dropping into the chair. R1’s physician and hospice staff stated that the way R1 transferred could have caused the fracture and that R1 had been cautioned against transferring in that manner. Additionally, staff and outside providers denied that R1 could have sustained the injury as the result of a fall due to R1’s inability to get up from the floor independently. Interviews with staff also revealed that prior to the discovery of R1’s fracture, R1 was independent of transferring needs but following the fracture, R1 required between two and three staff and the use of a gait belt to properly transfer. The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated. An exit interview was conducted with Business Office Manager Sam Elizondo , whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced case management visit. LPA was greeted by, identified herself to, and explained the purpose of the visit to Executive Director Candi Laird. This visit was initiated due to an incident report that was self reported by the facility to the Department on 4/12/2024. The incident report narrative described that sometime in April 2024, Resident 1 (R1) had reported to an outside source that an altercation between R1 and an unknown individual had occurred. The described altercation did not result in any injuries. The facility became aware of the alleged altercation when the outside source reported R1's statement to the facility management. The facility followed required reporting requirements to the Department and Long Term Care Ombudsman. During today’s visit, LPA toured the facility, observed residents in care, conducted a health and safety check, and reviewed and obtained copies of facility records. No immediate health or safety concerns were observed during the facility tour. No deficiencies were cited during today’s visit. An exit interview was conducted with Executive Director Candi Laird, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 03/22).

LPA Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Case Management – Incident visit. LPA was welcomed by, identified herself, and discussed the purpose of the visit with Executive Director Candi Laird. Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office (received on 03/13/2024). According to the LIC624: during the morning of 03/12/2024, an error by Staff #1 (S1) led to Resident #1 (R1) receiving doses of multiple medications which were not prescribed to them. These medications were instead prescribed to Resident #2 (R2). [See LIC 811 Confidential Names List for a description of select person identifiers used in this report]. During today’s visit, LPA performed a brief facility tour and welfare check on R1, verifying that they were safe. LPA collected copies of and reviewed pertinent care records, training records, and physician correspondence. LPA also interviewed relevant staff. Staff interviews aligned to show: On the morning of 03/12/2024, S1 was a newer Medication Technician and recently underwent medication pass training with a nurse manager. At breakfast time, Staff #1 approached R1 and asked R1 to verify his identity, R1 agreed to the wrong identity. R1 then ingested medications which were not prescribed to them. Staff quickly recognized the error and timely notified R1’s primary care physician (PCP). Staff measured R1’s blood pressure multiple times, finding it was consistently within a safe range. Staff continued to closely observe R1 for 72 hours and R1 had no adverse reactions. [Continued on 809-C] 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 [Continued from 809] Personnel records showed that Licensee provided one-on-one remedial medication pass training to S1 following the incident. No citations were issued at the time of visit however one (1) Technical Violation (TV) was issued.. An exit interview was conducted with Executive Director Candi Laird, to whom a copy of this report, the LIC9102-TV, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Executive Director Candi Laird. Today's visit was in response to an LIC624 Incident Report concerning Resident #1 (R1), which Licensee self-submitted to the CCLD San Diego Regional Office (they were received on 03/18/2024) [See LIC 811 Confidential Names List for a description of R1.] Per the reports: On 03/14/2024, Licensee’s staff arranged for R1 to be taken to a local emergency room due to change in their condition. R1 was admitted to hospital and then later moved to a Skilled Nursing Facility. During today’s visit, LPA performed a brief facility tour and welfare check on the remaining residents, finding no safety concerns. LPA also collected copies of and reviewed pertinent records and interviewed some of the relevant staff. No deficiencies were observed or cited during today’s visit. An exit interview was conducted with Executive Director Candi Laird, to whom a copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

Licensing Program Analyst (LPA) Amy Rodgers, made an unannounced visit to conduct the required One-Year Inspection. LPA Rodgers were granted entry into the facility by Health and Wellness Director Valorie Adams, after identifying herself and stating the purpose of the inspection. The facility serves 186 elderly residents, age 60 and above, all whom may be non-ambulatory. This facility is approved for delayed egress and locked perimeter. Later, Executive Director Candi Laird joined the tour. LPA was accompanied by Valorie Adams for a tour of the facility which was conducted inside and out and included a sample of resident units, the dining area and recreation rooms. Exterior and interior passageways were free from obstructions. Signal system is present and was operational. Resident and facility room temperatures were within a comfortable range. Each resident had clean and sufficient bed linens, towels, and washcloths. All residents’ rooms were equipped with required furnishings. Lighting was present in the bedrooms. Residents’ bathrooms were observed to be sanitary and operational. Toilets and showers were equipped with grab bars. Food menus and activities schedule were posted. Chemicals and cleaning supplies were stored in a locked closet. The medication carts were locked and medications were labeled and kept in compliance with label instructions. LPA interview confirmed the licensee provides assistance in meeting medical and dental needs. [Continued on 809-C] 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 [Continued from 809] LPA interviewed multiple staff and clients. LPA reviewed multiple staff and client records/files. The interviews did not raise any significant licensing concerns. The reviewed files contained all required documents. LPA also conducted a review of In-service training procedures. There are large designated activity rooms throughout facility as well as gathering areas throughout the facility. At the time of visit, LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs. A final exit interview and a copy of this report, Licensee/Appeal Rights - LIC 9058 (rev. 01/16), were provided to , Executive Director Candi Laird. whose signature on this form acknowledges receipt of these documents.

Interviews with staff and residents revealed that some residents had complained about small flying insects in their rooms during their weekly housekeeping visits. Staff stated that they would report to the front desk or the maintenance director whenever a resident complained about insects or the staff observed insects. Interviews and records review revealed that the front desk staff were responsible for generating a work order and logging the issue in a binder at the front desk for the contracted pest control company to address during their monthly visit. Interviews revealed that the contracted pest control company would review the binder at the front desk and address each logged concern. Records review revealed that the pest control company was present at the facility once a month and left a receipt detailing the work conducted with the maintenance director. Interviews with staff revealed that staff would attempt to address any issues with insects during weekly housekeeping visits by using cleaning products in the areas where insects were observed. Interviews with staff revealed that insects were a concern around this time of year and denied any residents who had consistent issues with insects in their room. Interviews with residents were inconsistent regarding the presence of insects in the facility and resident rooms. During the visit on 10/6/2023, LPA Ruiz observed multiple resident rooms, hallways, and common areas of the facility. LPA observed a few small flying insects in Resident 1’s (R1) room located around drink bottles and cups. Interviews with R1 revealed that the insects were attracted to open food containers and drinks which R1 admitted to leaving food containers out in the past. R1 stated that they did not wash drink cups or bottles with soap after they contained sugary drinks and only rinsed them out. R1 stated that they often ate meals in their room and returned any remaining food to the dining room after they completed their meal. R1 stated that the issue with insects had improved. The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated. An exit interview was conducted with Business Office Manager Raquel Tarango, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 01/16).

Review of physician’s report revealed that Resident 2 (R2) had a diagnosis of dementia, was confused, disoriented, and had wandering and Sundowning behaviors. Interviews with staff revealed that R2 had a history of wandering into other residents’ rooms but was redirectable. Interviews with staff revealed that on 1/17/2023, R1 was observed in a common area touching R2's genitals over R2’s clothing. Staff separated R1 and R2 and instructed R1 not to touch anyone. On 1/18/2023 at around 5:00 am, R1 and R2 were observed to be in R1’s room laying on the bed together while R1 was fully undressed and R2 was not wearing any clothing below the waist. R2 had their hand on R1’s genitals with R1’s hand covering R2’s hand. Staff called for assistance to separate both residents and called local law enforcement who responded to the facility. On 1/18/2023, facility management arranged and paid for R1 to have a private caregiver to provide 1 on 1 supervision in order to protect other residents, including R2. The private caregiver began supervising R1 on 1/19/2023. The private caregiver was tasked with ensuring residents did not enter R1’s room, accompanying R1 in common areas, redirecting R1 when they attempted to expose themselves or engage in inappropriate behaviors, and report all incidents to facility management. The private caregiver was also given a towel to cover R1 when they did expose themselves and escort R1 back to their room. Interviews with staff revealed that R1 had stated to staff on multiple occasions that they would stop touching and exposing themselves to staff and other residents, but R1 continued with their behavior. Interviews with R1 revealed that R1 understood that their behavior was inappropriate but continued to engage in those behaviors. On 1/19/2023, R2 reported to staff that they had genital pain and R2 was transferred to the hospital for evaluation. R2 returned to the facility the next day with no new medications or diagnosis. Interviews with R2 revealed that R2 could not recall any of the interactions with R1. Interviews with staff revealed that R2 could not understand that the interactions between R1 and R2 were inappropriate. On 1/20/2023, R1 was assessed by a medical professional and prescribed R1 a medication which calmed R1 but did not cause the behaviors to stop. Interviews with staff revealed that facility management reached out to R1’s responsible party who was not responsive to the facility’s steps to mitigate the behaviors. Continued on LIC9099-C page... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Interviews with staff revealed that R1 refused to be re-evaluated and became aggressive with staff when the topic of medical evaluation was discussed. On 1/26/2023, R1 was given a 30-day eviction notice for failure to follow facility rules and was evicted from the facility on 2/20/2023. Interviews with staff revealed that R1 did not have any incidents with other residents in which R1 was able to touch other residents once the private caregiver started on 1/19/2023. R1 continued to expose themselves to staff and other residents until R1 was evicted from the facility on 2/20/2023. The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated. An exit interview was conducted with Executive Director Christopher Burk, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 01/16).

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Executive Director Chris Burk. Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office (received on 05/20/2023), involving Resident #1 (R1). [See LIC 811 Confidential Names List for a description of R1]. According to the LIC624: on 05/15/2023, R1 had an unwitnessed fall beside their bed, inside their bedroom. R1 denied having pain, and staff’s initial assessment did not undercover any sign of injury. The next day on 05/16/2023, R1 complained of right hip pain and had a hematoma on their forehead, so staff arranged for R1 to be transported to the hospital. As of today’s CCLD visit (06/16/2023), R1 had already moved out of the facility. However, LPA performed a brief facility tour and welfare check on remaining residents in care, seeing no immediate safety concerns. LPA also reviewed pertinent care records and interviewed relevant staff. According to R1’s LIC602 Physician’s Report (dated 04/03/2022): while R1 was diagnosed with Mild Cognitive Impairment, their doctor clarified that R1 was not “confused/disoriented.” The doctor also wrote that R1 was “able to follow instructions” and “able to communicate needs.” According to the Plan of Care which licensee authored on R1 (dated 05/04/2023), R1 was “oriented to person, place and time” and “can communicate needs and preferences.” [CONTINUED ON LIC 809-C, 1 of 2] 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 [CONTINUED FROM LIC 809] According to staff interviews and corroborated by the facility’s date and time stamped progress/care notes: R1 was found on the floor beside their bed during the afternoon of 05/15/2023. R1 told responding staff, med tech Staff #1 (S1) and nurse Staff #2 (S2), that they slipped out of their wheelchair while trying to transfer themselves from bed. S1 wrote that R1 denied hitting their head, denied pain, and had no visible sign of injury. R1’s vital signs, to include blood pressure and pulse, were measured and were unremarkable. Staff notified R1’s responsible person and physician of the incident, and continued to observe R1. Staff #3 (S3) documented that they checked on R1 through the night, and that R1 slept soundly without pain or discomfort. Then on 05/16/2023, Staff #4 (S4) checked on R1; R1 now exhibited right hip pain. S4 wrote that R1’s hand was also swollen/bruised, and they saw a bump on the left side of R1’s forehead. S4 arranged for R1 to be transported to the hospital and updated R1’s responsible person and physician. However, when medical transport arrived for R1, they refused to be taken to the hospital and signed a waiver for the medical transport staff. S4 continued to dialogue with R1’s responsible person. S4 arranged medical transport to come back to the facility later that same day, and this time R1 agreed to go to a local hospital. According to staff interviews and corroborated by hospital discharge paperwork: R1 was soon released back to the facility, with their only identified injury being a “contusion” on their head. There were no bone fractures or hip or hand injuries identified. Progress/care notes and a faxed note to R1's doctor showed: after R1 discharged back to the facility, staff continued to provide increased observation to R1, and continued to communicate with R1’s responsible person and physician. Interviews and care documents revealed that R1 wore a pendant call device/button (which is used to summon staff for help) during the slip/fall incident. LPA reviewed an electronic signals log corresponding to R1’s pendant device for 05/15/2023. The log evidenced that facility staff quickly responded to each of R1’s three (3) pendant calls, which were spread out over this date. [CONTINUED ON LIC 809-C, 2 of 2] 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 [CONTINUED FROM LIC 809-C, 1 of 2] There does not exist a preponderance of evidence showing that licensee’s staff did not provide needed care or observation to R1, or that licensee did not arrange for needed emergency medical care for R1 when it became warranted. No deficiency was cited for the above incident. Also, no deficiency was observed or cited during today’s licensing visit. However, LPA identified one Technical Violation regarding Reporting Requirements, and provided education, accordingly. An exit interview was conducted with Burk, to whom a copy of this report, the LIC9102-TV, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.