Oceanside Senior Living.

Review of Resident 1’s (R1’s) medical and care assessment records dated 2021 revealed that R1 had mild cognitive impairment, was confused and disoriented, and required assistance with bathing, grooming, dressing, toileting and multiple safety checks per shift. While assessment records noted that R1 was not a fall risk, review of progress notes for R1 in 2021 revealed that R1 had multiple falls a month, usually with no injuries. Each time R1 fell, staff would assess R1 for any pain or injuries. Review of progress notes for R1 in 2021 revealed that in July 2021, R1 was found on the floor in a common area by staff and was observed to have minor injuries to the head and leg, and R1 complained of pain. Staff called 911 and emergency personnel assessed and transported R1 to the hospital. The Department was unable to obtain copies of R1’s discharge paperwork resulting in the Department’s inability to determine the severity of R1’s injuries. R1’s progress notes showed a pattern of staff conducting regular safety checks on R1, as well as encouraging R1 to attend communal meals and activities. Review of progress notes for residents revealed that an outside source complained that one staff working in the facility’s memory care was not sufficient to supervise residents overnight. Review of regulations regarding overnight supervision requirements for facilities caring for up to 100 residents revealed that at least one awake staff member was required to be on site with another staff on call and available to respond within 10 minutes. The Department was unable to interview any relevant staff that were working in 2021 or obtain staff schedules in 2021 to determine the staffing level in the facility’s memory care in 2021. However, interviews with staff responsible for oversight of the memory care in 2022 through 2024 revealed that the memory care was staffed with a minimum of 3 care staff during the morning and afternoon shifts, and a minimum of 2 care staff during the overnight shift. Those staff also stated that if a caregiver called out for a shift, other caregivers would be contacted to cover the shift, or the Memory Care Director would provide direct resident care. The Department has investigated the above-mentioned allegations and based on interviews and records review, the preponderance of the evidence has not been met, therefore, these allegations are deemed unsubstantiated. An exit interview was conducted with Executive Director Kristel Johnson, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 03/22).

Interviews and reviews of R1’s financial ledgers revealed that in May 2025, R1 stopped submitting payments for basic services and care rates. Interviews and review of assessment records from April and May 2025 revealed that R1 was declining cognitively and was moved into the facility’s memory care in late May 2025. Review of email exchanges between R1’s responsible party and facility management starting in late July 2025 revealed that both parties were in communications regarding managing R1’s finances and bringing R1’s balance in good standing. On August 1, 2025, the facility hand delivered an eviction notice to R1 regarding failure to pay for fees issued between May 2025 and July 2025 and mailed and emailed a written copy to R1’s responsible party. After not receiving any payment prior to the eviction notice’s effective date of September 1, 2025, the facility filed for an unlawful detainer with the San Diego County Superior Court on September 4, 2025. Email communications between R1’s responsible party and facility management documented that R1’s responsible party was in the process of having R1’s long term care insurance cover R1’s future basic rate and care fees starting in May 2025. Emails showed that R1’s responsible party mailed multiple physical checks to the facility, however, issues with dates and not covering the full amount of R1's outstanding balance caused the checks to be unable to be cashed. The facility did not receive any other payments until mid-January 2026, when the facility received and cashed a check which almost covered R1’s existing balance at that time. Interviews and review of a Notice to Vacate revealed that R1 was issued a notice to vacate by the San Diego Sheriff and R1 would be physically evicted on January 22, 2026. Interviews revealed that R1's responsible party submitted payments to the facility in January 2026, which settled R1's outstanding balance. Interviews with facility management revealed that the eviction through the local Sheriff was cancelled during LPA’s visit, and LPA Borunda verified that R1 remained at the facility and had not been evicted as of the end of today’s visit. The Department has investigated the above-mentioned allegation and based on interview 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 Kristel Johnson, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 03/22).

Review of outing sign-up sheets for June and July 2025 showed that the facility offered transportation to multiple different religious services on Sundays. Outing sign-up sheets revealed that R1 signed up for transportation for almost every single recreational outing and religious services in June and July. Interviews with activities staff revealed that the facility owned three vehicles, a bus with a wheelchair lift, a van with a drive-up ramp, and a spare bus given to the facility from a different community. Interviews revealed that the facility’s two buses required repairs, one of which would not be repaired until 7/23/2025. The facility’s van also required smog testing on 7/22/2025 to renew its vehicle registration and facility staff feared that the van would not pass the smog testing. Due to these concerns, the facility had been borrowing a bus from a sister facility when that bus was not already in use by the sister facility. Interviews with staff revealed that R1 attended all outings and religious services that R1 signed up for except for a religious service on one occasion. Staff stated that R1 and another resident used electric wheelchairs and had both signed up for the same religious service, causing staff to question if the borrowed bus, which was the only available vehicle, could accommodate the size of both wheelchairs. Additionally, interviews with staff revealed that the borrowed bus had a physically smaller wheelchair lift with a lower weight capacity than the facility’s normal bus. Interviews revealed that R1 refused to provide facility management with information on the weight of R1’s wheelchair when asked by staff. Additionally, staff stated that due to the smaller size of the lift, R1’s wheelchair wheels would have hung off the edges of the lift, putting R1 in a very unsafe situation. Interviews did not reveal any other instances where R1 was not able to attend outings. 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 Kristel Johnson, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 03/22).

Interviews with residents and staff revealed that the facility offered portable AC units to residents, however, some residents claimed that they were not offered portable AC units, fans, or any other cooling devices despite residents wanting those devices. Interviews with staff provided conflicting information, stating that some residents complained that the portable AC units were too noisy and residents did not want to use them. Interviews with residents and LPA observations of thermostat readings in resident rooms did not reveal any evidence that the temperature in resident rooms rose above 85 degrees. Review of work orders and interviews with staff revealed that an outside vendor assessed the facility’s AC system in late July 2025 and determined that there was a leak in the AC system, which the vendor fixed. Interviews with staff and residents revealed that the issue with the AC system took approximately two weeks to fix. The Department has investigated the above-mentioned allegation and based on interviews and observations, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated. An exit interview was conducted with Executive Director Kristel Johnson, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 03/22).

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced case management visit to continue the annual started on 10/20/2025. LPA identified herself to and explained the purpose of the visit with Business Office Manager Nishimwe Valentin. Executive Director Kristel Johnson arrived during the visit. During today's visit, LPA observed residents in care, reviewed facility records, and toured the facility. 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 Kristel Johnson, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).

LPA observations during multiple on-site visits between January and May 2025 did not reveal any instances of staff interacting with residents, including R1, in an inappropriate, disrespectful, or rude manner. Interviews with R1, residents, staff, and LPA observations revealed that R1 could be difficult to interact with due to R1’s personality. During interviews, staff and residents expressed a desire to avoid interactions with R1 due to R1’s video recording behaviors and personality. Interviews and records review revealed that R1 was evicted from the facility in early October 2025 due to violating house rules regarding treating residents and staff with respect. Review of R1’s financial statements from November 2024 to October 2025 revealed that R1 had monthly reoccurring charges for basic room and board and R1 did not receive any care, resulting in R1 not being charged for any care. Review of R1’s admission agreement revealed that the facility would charge a late fee of $250 for any payments received after the fifth day of the month. Despite R1 submitting payment for basic room and board after the 5 th of the month on multiple occasions, R1 was not charged a late fee. Additionally, multiple interviews with R1 did not disclose any concerns that R1 was charged for services that R1 did not receive or were not previously explained. The Department has investigated the above-mentioned allegations and based on interviews, record review, and observation, the preponderance of the evidence has not been met, therefore, these allegations are deemed unsubstantiated. An exit interview was conducted with Executive Director Kristel Johnson, 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 Kristel Johnson. During today's visit, LPA observed residents in care and reviewed facility records. 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 Kristel Johnson, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).

Interviews with R1 and outside sources revealed that R1 and their responsible party had multiple discussions with facility management, including the Executive Director (ED) regarding refunding one of the payments. Review of email communication between facility staff and the facility corporate office revealed that on 5/6/2025, the Business Office Manager sent an email to the corporate billing office explaining the situation including that R1’s responsible party had requested a refund check, not a credit to their billing account, and that the facility was requesting a refund of one of the payments. Between 5/9/2025 and 5/16/2025, the ED sent multiple emails requesting follow-up on the refund request for R1 with no response from the corporate office. On 5/20/2025, the basic service rate for June 2025 posted in the facility’s electronic billing system, which automatically applied the overpayment for May 2025 to the June charges. Emails from the corporate office on 5/21/2025 stated that because the June charges had already been added to the billing system and R1’s financial ledger showed a balance of $0, the facility was unable to refund R1’s overpayment from May 2025. As of 6/2/2025, the facility has not issued R1 or their authorized representative a refund check for the overpayment for May 2025. Facility management did not deny during interviews that the facility received two payments for R1’s basic service rate for the month of May and that R1’s account showed an overpayment between 5/6/2025 and 5/20/2025. Review of R1’s admission agreement signed 3/27/2025 revealed that according to the facility’s refund policy regarding unused portions of the monthly fee, any extra money would be refunded within 30 days of the termination of the agreement upon relocation from the facility or resident death. However, R1’s agreement was still valid as of 6/2/2025, since R1 had not relocated from the facility or had died. Review of regulations did not reveal any regulations that would require the facility to issue a refund check instead of applying the overpayment to future billing charges. 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 Kristel Johnson , 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 case management visit to conduct follow up regarding an incident report. LPA was greeted by, identified herself to, and explained the purpose of the visit with Executive Director Kristel Johnson. On 5/21/2025, the Department received an incident report from the facility that described that on 5/6/2025, Resident 1 (R1) was found unresponsive in their room by facility staff. Staff called 911 and performed CPR until emergency personnel arrived. Emergency personnel contacted a physician via telephone. R1 was pronounced dead by the physician over the phone. Law enforcement also responded to the facility in regards to the death. During today’s visit, LPA observed residents in care, and reviewed and obtained copies of facility records. LPA Borunda requested a copy of R1's death certificate when it became available from Executive Director. Additional investigation may be needed following review of R1's death certificate. No deficiencies were cited on today’s date. An exit interview was conducted with Executive Director Kristel Johnson, 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 announced case management visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Executive Director Kristel Johnson . During today's visit, LPA provided Executive Director Kristel Johnson with guidance and consultation regarding facility documentation, reporting requirements, staffing, and eviction procedures. No deficiencies were cited on today’s date. An exit interview was conducted with Executive Director Kristel Johnson, 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 to conduct follow up regarding an incident report. LPA was greeted by, identified herself to, and explained the purpose of the visit with Executive Director Jackie Banks. On 11/5/2024, the Department received an incident report from the facility which described that on 11/1/2024 at approximately 4:45am, Resident 1 (R1) was discovered by facility staff outside in the internal courtyard and had sustained multiple injuries. [Executive Director was provided with an LIC811 Confidential Names List to identify R1] Staff assessed R1 and brought R1 back inside and staff called 911 after R1 was observed to be confused and disoriented. R1 was transported to the hospital where R1 received treatment for the injuries and returned to the facility the same day. During today’s visit, LPA conducted a health and safety check, observed residents in care, including R1, and reviewed and obtained copies of facility records. No deficiencies were cited on today’s date. An exit interview was conducted with Executive Director Jackie Banks, whose signature below confirms receipt of a copy of this report, the LIC811 and the Licensee Appeal Rights (LIC9058 3/22).

Review of R1’s physician report dated January 2024 and pre-appraisal assessment records dated 1/27/2024 revealed that R1 did not have any memory impairment, had a diagnosis of heart disease, was confused, but able to follow directions and communicate needs, was not able to administer or store own medications and was not receiving hospice services. Review of facility progress notes for R1 revealed that in early February 2024, R1 was observed by facility staff to have a change in condition and was experiencing increasing confusion. R1 was transported to the hospital where R1 received medication and treatment for a urinary tract infection. On 2/21/2024, R1 expressed feeling drowsy to facility staff and staff notified R1’s spouse. R1’s spouse spoke to R1’s primary physician who requested that R1 be sent to the hospital. Facility staff called 911 and R1 was assessed to be lethargic and non-responsive by paramedics. Paramedics administered a Narcan injection and transported R1 to the hospital, where R1 was admitted and treated for a urinary tract infection. At the hospital, R1 tested positive for narcotics during urine analysis testing. R1 was discharged back to the facility on 2/23/2024 and was readmitted to the hospital on 2/24/2024 after displaying stroke-like symptoms. R1 was moved out of the facility on 2/27/2024 and review of R1’s death certificate revealed that R1 passed away on 3/5/2024 with the cause of death listed as cerebral atherosclerosis and unspecified heart failure. Additionally, R1’s death certificate did not list the presence of narcotics in R1’s urine, the Narcan administration on 2/21/2024, or any other conditions as having contributed to R1’s death. Review of R1’s medication record dated 2/29/2024 and interviews with facility staff revealed that R1 was not prescribed any narcotic medications and staff denied administering narcotic medications to R1. Interviews with facility staff revealed that all narcotic medications are stored in a locked cabinet in the medication room and are counted at the beginning of each shift by medication technicians. Interviews with staff and R1’s progress notes stated that R1’s spouse notified facility staff on 2/21/2024 that R1 had tested positive for narcotics and the Resident Care Director and medication technicians on shift conducted an additional narcotic medication count that day and did not discover any inconsistencies. Review of narcotic count records for February 2024 did not reveal any inconsistencies with narcotic medication counts for residents at the facility. 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 an outside medical professional revealed that the administration of Narcan could cause a false positive on a drug screening. Additionally, the outside medical professional stated that the administration of Narcan and the potentially false positive narcotic result were not a direct cause of death for R1. Interviews with staff and outside sources and review of records did not reveal how R1 could have taken the narcotics. The Department has investigated the above-mentioned allegations and based on interviews and records review, the preponderance of the evidence has not been met, therefore, these allegations are deemed unsubstantiated. An exit interview was conducted with Business Office Manager Virginia Rodriguez, 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 - Annual Continuation 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 Resident Care Director Kristel Johnson. Executive Director Jackie Banks arrived during the visit. LPA was away from the facility for approximately one hour between 12:15pm and 1:15pm. The facility is licensed for a maximum capacity of 165 non-ambulatory residents, 6 of which may be bedridden in identified rooms. The facility has a waiver for 15 hospice residents. During today’s visit, the facility had a census of 103 residents. The Administrator for the facility is Jackie Banks and their certificate was valid and current. During visits on 8/15/2024 and 8/26/2024, LPA toured the facility and inspected a random sampling of resident rooms, private and common bathrooms for resident and staff use, kitchen, common areas, and outside space. No bodies of water were observed on the premises. LPA observed delay egress in the facility's memory care which is approved by the facility's fire clearance. The facility was found to be clean, safe, and in good repair with no pathway obstructions. The facility’s water temperature was measured at 105.7, 108.0, 109.9, 114.6 and 115.3 degrees Fahrenheit in a random sampling of resident bathrooms. The facility’s internal temperature was measured at 73 and 74 degrees Fahrenheit in different parts of the facility. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. According to Jackie Banks, no firearms or weapons are stored on the premises. LPA also observed locked storage for resident medications and resident and staff files. Resident medications are stored in their original container and labelled. Continued on LIC809-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 LPA observed a minimum of a 2-day supply of perishable food and a 7-day supply of non-perishable food present at the facility. The facility refrigerator was kept at 37 degrees Fahrenheit, and the facility freezer was kept at -7 degrees Fahrenheit. LPA observed linens and hygiene products provided to the residents that are in good repair and sufficient to meet their needs. LPA reviewed multiple resident and staff records. Each resident record was complete and contained a signed admission agreement, updated physician’s report and medical assessment, documents regarding safeguarding personal property, and personal rights. LPA spoke with staff and residents present at the facility during the time of the inspection. The Executive Director will submit copies of the LIC500 Personnel Report, LIC610E Disaster Plan, and current liability insurance to the Department within 15 business days. No deficiencies were cited on today’s date. An exit interview was conducted with Executive Director Jackie Banks, 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 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 Jackie Banks. 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. LPA was away from the facility for approximately one hour between 12:15pm and 1:15pm. No deficiencies were cited during today's visit. An exit interview was conducted with Executive Director Jackie Banks, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).

Licensing Program Analyst (LPA) Amy Rodgers, made an unannounced visit to conduct the required One-Year Inspection to ensure substantial compliance with Title 22 regulations. LPA Rodgers was granted entry into the facility by Sales Director, Jiovani Anderson-Diaz after identifying herself and stating the purpose of the inspection. The facility serves one hundred sixty five (165) non- ambulatory elderly residents age sixty (60) and above; of which six (6) may be bedridden and may use designated rooms. There is an approved hospice waiver for fifteen (15). With approval for delayed egress and secured perimeters.. LPA was accompanied by the Sales Director, Jiovani Anderson-Diaz during a tour of the facility. Tour was conducted inside and out and included a sample of resident units, the dining area, recreation rooms, and food storage areas. Signal systems are in place and operational. The last disaster drill was conducted in October 2023. No bodies of water are on premises. Passageways were free from obstructions. According to Sales Director Anderson-Diaz, there are no weapons and/or ammunition stored on the premises. Call box was available in each resident unit and were tested for functionality. Resident's room temperatures were within a comfortable range. Each resident had clean and sufficient bed linens. All extra linens towels, and washcloths are all accessible in rooms or in locked hall closet. 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. Hot water temperature in residents’ bathrooms were compliant. [CONTINUED ON LIC 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 LIC 809] Facility has a two-day supply of perishable food and a seven-day supply of nonperishable food items. Food supply is replenished frequently by outside vendors. Food was observed to be properly stored and labeled. Food menus and activities schedule were posted. Chemicals and cleaning supplies were stored in a locked cabinet. Medications were labeled, as required, and stored in locked areas. Staff records review verified that all staff have Criminal Record Clearance, Personnel Record, TB clearance, and Health Screening Report, and required training. At the time of visit current First Aid certificats and First Aide/CPR certificates could not be produced. Resident records reviewed for a current Physician's Report, Resident Appraisal, Needs & Services Plan, Identification and Emergency Information, Admission Agreement, and Centrally Stored Medication. Administrator’s certification is current. LPA reviewed the theft and loss policy and procedures. Conducted a thorough review of In-service training procedures. Transportation procedures were reviewed and complaint. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs. An exit interview was conducted, this report was discussed with Sales Director, Jiovani Anderson-Diaz. The report along with Licensee/Appeal Rights (LIC 9058 01/2106), and their signature on this form acknowledges receipt and a copy of the report was given to the by Sales Director, Jiovani Anderson-Diaz.