OCEANVIEW LIVING OF SAN PEDRO

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General, (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above. Staff #1 and #2, did not have a valid First Aid/CPR certificate on file. This violation poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/21/2026 Plan of Correction Licensee will ensure all staff who have direct care with residents must have completed First Aid/CPR training. Proof of correction must be sent to LPA Elvira.Gonzalez@dss.ca.gov

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

87411(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above. The department identified staff #1 did not have a TB test on file, and staff #2 did not have TB test or Health Screening on file. This violation poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/21/2026 Plan of Correction Licensee will ensure that all staff have Health Screening and TB tests on file. Proof of correction must be sent to LPA Elvira.Gonzalez@dss.ca.gov

Official classification

Type A

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care: (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement was not met as evidence by: Based on records and interviews conducted the licensee did not ensure that staff immediately call 911 on 01/20/2025, staff did not immediately call 911 for R1 who was complaining of pain, this posed an immediate health, safety and personal risk to residents in care.

Official plan of correction

The administrator agreed to provide additional training to staff on seeking timely medical assistance for residents in care, proof of correction will be submitted to jose.calderon@dss.ca.gov.

Deadline recorded: Apr 30, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87463(a-b)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals (a)The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. (b) The reappraisal shall document significant changes in the resident's physical, mental, cognitive, behavioral, or functional condition, including those required to be documented as specified in Section 87466, Observation of the Resident. This requirement was not met as evidence by. Based on records review and interviews conducted, the licensee did not ensure that staff did a reappraisal of R1, after an unwitnessed fall that resulted in hospitalization on 12/13/2024. This poses an immediate health, safety and personal rights risk to residents in care.

Official plan of correction

The administrator agreed to create a plan to ensure that reappraisals are conducted for residents after falls resulting to hospitalizations, proof of correction will be submitted to jose.calderon@dss.ca.gov.

Deadline recorded: Apr 30, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gain or losses or deterioration of mental ability or physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person. This requirement was not met as evidence by: Based on records and interviews conducted, the licensee did not ensure appropriate assistance after R1’s initial fall on 12/13/2024. No fall prevention plan or intervention was implemented, resulting in a second fall on 01/20/2025 that caused serious injuries that led to R1’s death. This posed an immediate health, safety and personal rights risk to residents in care.

Official plan of correction

The administrator agreed to create a plan that includes documenting all changes in residents’ physical, mental, emotional, and social functioning, ensuring timely notification to physicians and responsible persons, and implementing a fall‑prevention assessment. And that staff will be provided with training on the said plan within 10-days, and proof of correction will be submitted to jose.calderon@dss.ca.gov.

Deadline recorded: Apr 30, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

82708

Regulation authority

CCR

What the official deficiency says

82708 The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49 This regulations was not met by the following evidence: Interviews and observations indicates the Licensee is operating a sober living entity on-site that is not part of the approved plan, posting a health and safety risk to residents

Official plan of correction

Corrected at time of visit

Deadline recorded: Feb 10, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. Based on observation and interviews the conducted the right side of the sink in the 2nd floor kitchenette is clogged and draining slowly. This poses a potential health and safety risk to residents in care.

Official plan of correction

Facility maintenance staff used snake to unclog the right side of the 2nd floor kitchenette sink, citation was cleared while LPA was still at the facility.

Deadline recorded: Feb 25, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87208

Regulation authority

CCR

What the official deficiency says

87208 The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49 This regulations was not met by the following evidence: Interviews and observations indicates the Licensee is operating a sober living entity on-site that is not part of the approved plan, posting a health and safety risk to residents

Official plan of correction

Corrected at time of visit

Deadline recorded: Feb 10, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1 (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: The licensee did not ensure residents are accorded safe and healthful accommodations, as record review and interviews revealed incomplete resident face sheets and records for R1-R6 and that staff S1 was unable to provide complete health information to first responders, posing a potential health and safety risk to residents in care.

Official plan of correction

Licensee agreed to submit a plan by the due date to ensure all resident records are complete and consistent and submitted to LPA: at Jose.Anguiano@dss.ca.gov

Deadline recorded: Feb 26, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87208(a)(1-10)

Regulation authority

CCR

What the official deficiency says

We will move forward with dismissing the citation issued to Ocean View on Plan of Operation as facility is currently working with the department to further clarify their policies and procedures related to video surveillance and because there is no clear evidence to a health and safety concern.

Deadline recorded: Oct 31, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical,..needs. When changes in...physical health..., the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician...if any. This has not been met as evidenced by LPA's interviews and record review, the licensee did not ensure that a change in R1's physical need(s) have been reported to R1's physician which poses a potential health risk to residents in care.

Official plan of correction

Administrator and LPA have agreed that documentation in crossover notes are to be recorded for any changes in physical, mental, emotional and social functioning of the residents in care. LPA has also requested the facility to forward any special incidents (LIC624) that take place during residents' stay at this facility. Administrator will forward all relevent documentation of this training, signed and dated by staff present, including those who presented the information, via email, to MARIO.LEON@DSS.CA.GOV

Deadline recorded: Sep 30, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care ...The licensee shall assist residents with self-administered medications as needed. This requirment has not been met as evidenced by: On 09/11/2024 LPA Troy Watson observed on eMAR that medications had been missed for residents 1-4 for the month of September 2024. This is a potential health and safety risk to clients in care.

Official plan of correction

Administrator will conduct staff medication training. Facility will provide copies of transcripts to CCL via email/fax by POC due dates.

Deadline recorded: Nov 22, 2024. A deadline is not proof that correction was completed.