374601952-9-9-2026-08-AS-SMAZ-DXZSAP-20260917134241

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374601952
Report Date: 09/09/2026
Date Signed: 09/09/2026 11:41:07 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
09/02/2026 and conducted by Evaluator Marisela Garcia-Centeno

COMPLAINT CONTROL NUMBER: 08-AS-20260902151420

FACILITY NAME:	BROOKDALE OCEANSIDE		FACILITY NUMBER:	374601952
ADMINISTRATOR:	MCCOY, MICHAEL		FACILITY TYPE:	740
ADDRESS:	3524 LAKE BLVD		TELEPHONE:	(760) 945-1811
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92056
CAPACITY:	186	CENSUS: 97	DATE:	09/09/2026
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Executive Director Mike McCoy		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Neglect/ Lack of supervision resulted in resident sustaining a bruise
Facility was disrepair

INVESTIGATION FINDINGS:

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On September 8, 2026, Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to initiate an investigation regarding the above allegations. LPA met with Executive Director Mike McCoy and discussed the purpose of the visit.

The Department's investigation included a facility tour, review of facility records, and interviews with relevant parties.

Allegation: Neglect/lack of supervision resulted in R1 sustaining a bruise.
On September 8, 2026, Community Care Licensing (CCL) received a complaint alleging that neglect and lack of supervision resulted in R1 sustaining a bruise.

(continue at LIC9099C)

Unsubstantiated

Estimated Days of Completion: 90Days

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2026

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-20260902151420

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: BROOKDALE OCEANSIDE	FACILITY NUMBER: 374601952
	VISIT DATE: 09/09/2026

NARRATIVE

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(continue from LIC9099)

During an interview, an outside source (OS) stated that a bruise had been observed on R1's lower back several months prior. The specific date the bruise was observed was not provided during the investigation. OS also reported observing a raised lesion on R1's lower back and stated that the concern had been reported to facility staff.

During interviews, staff stated that an outside source had recently reported a raised area on R1's back and requested that R1 be evaluated by a physician. Staff stated that R1's Power of Attorney (POA) had requested that R1 not be released to the outside source and that R1's physician had recently been changed.

Staff stated that R1 was assessed by direct care staff and the facility's Registered Nurse (RN). Staff reported that the raised area described by the outside source was determined to be a raised mole.

During the facility visit, R1 was observed without visible signs of injury to the back or other visible areas of the body. During an interview, R1 stated that R1 was fine and denied experiencing pain. R1 also stated that R1 did not recall falling or injuring the back.

Staff reported that R1 sustained a fall on August 26, 2026. The incident was reported to CCL in accordance with Title 22 requirements. Staff stated that R1 sustained a slight bruise to the back as a result of the fall and did not sustain a major injury. R1's Service Plan was updated following the incident to address R1's identified care and supervision needs. Staff reported that R1 uses a wheelchair for mobility and also uses a walker.

The investigation did not yield corroborating evidence to establish that R1's reported bruise was the result of staff neglect or lack of supervision. Therefore, the allegation is unsubstantiated.

Allegation: Facility was in disrepair.
It was reported that the facility was in disrepair. Specifically, it was alleged that a leak had been observed in a hallway, with a bucket placed underneath the leak to collect water dripping from the air-conditioning (AC) vents. The outside source expressed concern regarding possible mold.
(continue at LIC9099C)

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2026

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20260902151420

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: BROOKDALE OCEANSIDE	FACILITY NUMBER: 374601952
	VISIT DATE: 09/09/2026

NARRATIVE

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(continue from LIC9099C)

During the September 8, 2026 facility tour, no active leaks were observed. The facility was observed to be clean, organized, and free of offensive odors. Hallways were observed to be free of clutter.

During interviews, staff stated that the facility had experienced leaks associated with the Heating, Ventilation, and Air Conditioning (HVAC) system and that pumps had been replaced to address the issue. Staff reported that approximately 17 pumps had recently been replaced since the facility's new ownership. Staff also stated that ceiling tiles are replaced when water damage occurs.

Staff reported that the facility is more than 57 years old and that additional HVAC pumps may need to be replaced as needed.

The investigation did not yield corroborating evidence to establish that the facility was in disrepair at the time of the investigation. No active leaks or other conditions indicating that the facility was in disrepair were observed during the facility tour. Therefore, the allegation is unsubstantiated.

Based on the investigation, including facility observations, record review, and interviews, the evidence was insufficient to substantiate either allegation. Therefore, the allegations of neglect/lack of supervision resulting in R1 sustaining a bruise and facility being in disrepair are deemed unsubstantiated.

An exit interview was conducted with Executive Director Mike McCoy. A copy of this report and the Licensee Appeal Rights (LIC 9058 03/22) were provided to the Executive Director at the conclusion of the visit.

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2026

LIC9099 (FAS) - (06/04)

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