Oceanside Retirement Living

Type of visit: Required - 1 Year

At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Required-1 Year inspection. LPA met with caregiver Susi Susilawati and explained the purpose of the visit. Facility has a Hospice waiver for 2 residents. At approximately 8:45AM, LPA toured the facility to ensure the health and safety of residents in care. The facility was observed to be at a comfortable temperature. Areas toured include but are not limited to resident rooms, common areas, bathrooms, kitchen, storage areas and back yard. LPA observed a hook and latch device installed at the top of the back door to prevent it from opening. The front door privacy chain was installed at the top of the door to prevent residents from opening the door. LPA instructed staff the device on the back door needed to be removed and the front door chain needs to be moved to shoulder height as designed or removed. LPA observed screw holes at the proper location where the chain was previously installed. LPA measured hot water temperature in the resident bathroom and observed it was above regulation at 121.2 degrees F. Fire extinguishers were fully charged. Smoke detectors are all operational. Carbon Monoxide Detector was present. The common areas and bathrooms were clean and in good repair. All bedrooms had required furniture, bedding, and lighting. The kitchen equipment was clean and in good repair. Dishware appeared to be stored in a sanitary manner. Food appears to be stored and prepared properly. Refrigerators and freezers were maintained at the proper temperature. LPA observed medication stored in an unsecured kitchen drawer and unsecured small refrigerator. Facility has required seven-day non-perishable and two-day perishable supply of food. Facility can be self-sufficient for 72 hours. Facility has a generator to supply power in an emergency. Emergency lighting devices were present. First aid kit was present. No pools/bodies of water are on the premises. Facility has been conducting Emergency drills every 3 months and are overdue for a drill. The water temperature and unsecured medications are repeat violations in a 12 month period. An immediate civil penalty is being issued in the amount of $250 for each repeat violation totalling $500. Continued on LIC809-C… At approximately 9:55AM, LPA reviewed 3 resident files. 1 of 3 residents did not have a current care plan. 1 of 1 residents on Hospice did not have a Hospice care plan on file. LPA requested Licensee contact the Hospice agency to acquire a copy of the care plan. Documentation of a physician visit within the last 12 months was present. Medication records were organized and contained orders for each medication. Medications were secured in a locked cabinet with the of exception of the medication in the kitchen and refrigerator. At approximately 10:45AM, LPA reviewed 4 staff files. 1 of 4 files reviewed did not have evidence of completed annual training. Administrator record showed the administrator certificate expired 08/6/2026. 1 of 4 records did not contain evidence of First aid/CPR training. All employees requiring background checks are cleared. LPA observed the facilities lease agreement expired on 7/14/2026. LPA is requesting an updated Lease agreement. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: Evidence of control of Property, (Current Rental/Lease Agreement/Deed) LIC500- Personnel Report LIC610E- Disaster Plan Evidence of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Susi Susilawati and Appeal rights were given.the state’s words, verbatim · CDSS document, Sep 11, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(e)(2) · Plan of correction due date: Sep 23, 2026

(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall...attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: Based on observation, water temperature measured at 121.2 at faucets accessible to residents, which poses an immediate Health, Safety or Personal rights risk to residents in care. This is a repeat violation in a 12 month period. An immediate civil penalty is being issued for $250.the state’s words, verbatim · CDSS document, Sep 11, 2026

Plan of correction: Water Heater was adjusted during visit. Licensee agrees to monitor water temperature twice daily for seven days to ensure water temperature is within regulation. Temperature log shall be submitted to CCL by 09/23/2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87468.1(a)(6) · Plan of correction due date: Sep 12, 2026

(6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This requirement is not as evidenced by: Based on observation, the rear door and front door were secured in such a manner as to prevent residents from leaving. This poses an immediate Health, Safety or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 11, 2026

Plan of correction: Licensee agrees that residents have the right to leave the building. The locking devices were removed from the back door and moved to an appropriate location on the front door. Audible devices were activated. Violation cleared during visit.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Sep 12, 2026

(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on observation, Medication was stored in an unsecured kitchen drawer and unsecured refrigerator, which poses an immediate health, safety or personal rights risk to persons in care. This is a repeat violation in a 12 month period. An immediate civil penalty is being issued in the amount of $250.the state’s words, verbatim · CDSS document, Sep 11, 2026

Plan of correction: Licensee agrees that all medications shall be secured and not accessible. Medication was secured during visit. Violation cleared during visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87405(a) · Plan of correction due date: Oct 2, 2026

87405 Administrator - Qualifications and Duties:(a) All facilities shall have a qualified and currently certified administrator. This requirement is not met as evidenced by: Based on records reviewed, the Licensee nor Administrator have a current or in process Administrator Certificate. This poses a potential Health, Safety or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 11, 2026

Plan of correction: Licensee agrees to ensure the facility has a certified administrator. Licensee shall submit paperwork to appoint a currently certified Administrator or evidence of current administrator certificate has been renewed. Paperwork shall be submitted by 10/02/2026.

Type of visit: Required - 1 Year

At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Required-1 Year inspection. LPA met with Administrator Ecaterina Kabai and explained the purpose of the visit. Administrator certificate is current. Facility has a Hospice waiver for 2 residents. At approximately 8:45AM, LPA toured the facility to ensure the health and safety of residents in care. The facility was observed to be at a comfortable temperature. Areas toured include but are not limited to resident rooms, common areas, bathrooms, kitchen, storage areas and back yard. LPA measured hot water temperature and observed it was above regulation. Fire extinguishers were fully charged. Smoke detectors are all operational. Carbon Monoxide Detector was present. The common areas and bathrooms were clean and in good repair. All bedrooms had required furniture, bedding, and lighting. The kitchen equipment was clean and in good repair. LPA observed mold growing on the wall behind and to the side of the stove. Dishware appeared to be stored in a sanitary manner. Food appears to be stored and prepared properly. Refrigerators and freezers were maintained at the proper temperature. Facility has required seven-day non-perishable and two-day perishable supply of food. LPA observed prepared medication in a drawer in the kitchen under several pot holders and 4 bottles of over the counter medication in an unsecured cupboard. Facility can be self-sufficient for 72 hours. Facility has a generator to supply power in an emergency. Emergency lighting devices were present. First aid kit was present. No pools/bodies of water are on the premises. Facility has been conducting Emergency drills every 3 months. At approximately 9:15AM, LPA reviewed 3 resident files. All resident files contained the required documentation. Reappraisals were conducted within the last 12 months. Documentation of a physician visit within the last 12 months was present. Medication records were organized and contained orders for each medication. Medications were secured in a locked cabinet with the of exception of the medication in the kitchen. Continued on LIC809-C… At approximately 10:00AM, LPA reviewed 4 staff files. Staff files reviewed contained evidence of completed annual training. First Aid/CPR certification was current. All employees requiring background checks are cleared. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: Evidence of control of Property, (Current Rental/Lease Agreement/Deed) LIC500- Personnel Report LIC610E- Disaster Plan Evidence of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Ecaterina Kabai and Appeal rights were given.the state’s words, verbatim · CDSS document, Oct 13, 2025

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Allegation investigated: Staff did not allow a resident to leave the facility.

At approximately 9:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to open an investigation into the above allegation. LPA met with Administrator Kathy Kabai, interviewed residents and reviewed records. LPA received copies of documents. Based on interviews conducted, Licensee did not allow resident to leave the facility. On 10/27/2024, Resident expressed a desire to visit a family member and had transportation secured. Facility staff refused to allow resident to leave. After several conversations with CCLD and the Ombudsman's office, Licensee agreed they were wrong and agreed to take resident to visit their family. LPA provided a copy of regulation 87468.1, Personal Rights of Residents in all facilities for review. Based on the Departments investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Kathy Kabai and Appeal rights were given. Substantiatedthe state’s words, verbatim · CDSS document, Nov 1, 2024 · control 21-AS-20241029131525

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(6) · Plan of correction due date: Nov 4, 2024

87468.1 Personal Rights of Residents in All Facilities: (6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This requirement is not met as evidenced by: Based on interviews conducted, Licensee did not allow resident to leave the facility. This poses an immediate personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 1, 2024

Plan of correction: Licensee shall review personal rights regulation and retrain all staff on personal rights. Licensee shall submit signed statement from all staff, to CCLD that they have read and understand the regulation. Signed statement shall be submitted to CCL by POC date of 11/04/2024.

Type of visit: Case Management - Other

At approximately 9:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a complaint investigation. LPA met with Administrator Kathy Kabai. During this visit, LPA spoke with Administrator about the facilities lack of Liability insurance. Kathy told LPA they are working on securing the required insurance. LPA provided copy of the Health and Safety code regarding Liability insurance. Administrator will send evidence of liability insurance to CCL when received. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Kathy Kabai and Appeal rights were given.the state’s words, verbatim · CDSS document, Nov 1, 2024

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.605 · Plan of correction due date: Nov 15, 2024

1569.605 Liability insurance; coverage requirements:On and after July 1, 2015, all residential care facilities for the elderly...shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate. This requirement is not met as evidenced by: Based on records reviewed, Licensee does not have Liability insurance, which poses a potential risk to residents in care.the state’s words, verbatim · CDSS document, Nov 1, 2024

Plan of correction: Licensee to secure Liability insurance in the amounts required by law. Licensee to submit evidence of Liability insurance to CCL by POC date of 11/15/2024.

Type of visit: Required - 1 Year

At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Required-1 Year inspection. LPA met with Licensee Kathy Kabai and explained the purpose of the visit. Administrator certificate is current. LPA toured the facility to ensure the health and safety of residents in care. Areas toured include but are not limited to resident rooms, common areas, bathrooms, kitchen, storage areas and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. Staff and resident files were reviewed. Staff on duty did not have evidence of completed required training and did not have First Aid/CPR certification. Medications were reviewed. Licensee was preparing medication in advance. The common areas, bathrooms and kitchen were clean and in good repair. All bedrooms had required furniture, bedding, and lighting. Food appears to be stored and prepared properly. Facility has the required amount of non-perishable and perishable food items. Medication is locked and not accessible. The facility was observed to be at a comfortable temperature. First aid kit was present. Fire extinguishers were fully charged. Smoke detectors are all operational. Carbon Monoxide Detector was present. All employees requiring background checks are cleared. No pools/bodies of water are on the premises. Facility has been conducting drills every 3 months. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report Evidence of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.the state’s words, verbatim · CDSS document, Sep 4, 2024

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst Chris Arnhold arrived announced to conduct a Pre-licensing Facility Inspection with applicant. Facility has received fire clearance for four non-ambulatory residents, one of which may be bedridden. Applicant has a received a Hospice Waiver for two residents. Facility has included Dementia Care in the Plan of Operation but will not be advertising for dementia. Physical Plant: Facility is a single story, three bedroom and 1 bath home. Required postings were not present. Resident's bathroom is located in common hallway. Night light was not present in hallway. Grab bars and nonskid mat were present. Hot water temperature was 122.1F, which is above regulation. There is a secure area for medication storage. There were extra towels, linens and hygiene products for resident use. Kitchen appliances, utensils, and food preparation areas are in good condition. A seven day supply of non-perishable food was present. Stove knobs can be easily removed when stove is not in use. Toxins and cleansers are secured in the laundry area. One fire extinguisher is located in kitchen and another in the living room. All exits have functional auditory alarms. Smoke detectors are operational. Carbon monoxide detector is present. Windows, doors, walls, ceilings, screens, ramps, paint, and furniture are in good condition. Component III Orientation was conducted at the time of this inspection. Based on the findings during this inspection the following items require completion: -Bedroom 1 needs a chest of drawers and a lamp -Bedroom 3 needs a chest of drawers for each resident and a lamp. -Hot water temperature to be monitored and stay within regulation -Night light near the bathroom -Required postings Applicant will submit self certification that the requested items have been completed. Upon receipt of self certification, LPA will submit this application for review and approval of license to the Licensing Program Manager.the state’s words, verbatim · CDSS document, Nov 16, 2023