Sun and Sea Assisted Living

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) conducted an unannounced visit to conduct a case management visit in response to a report submitted by facility dated 08/06/2026. LPA disclosed the purpose of the visit with Facility Director Jay Agustin. During the visit, LPA reviewed files and requested records related to the report. No deficiencies were cited in accordance with the California Code of Regulations. An exit interview was conducted with Facility Director Jay Agustin, to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided. The signature below confirms the documents were received.the state’s words, verbatim · CDSS document, Aug 12, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Jose De La Cruz conducted an unannounced visit to amend an investigation report. LPA was greeted by and met with Executive Director (ED) Jay Agustin and to discuss the purpose of the visit. During today's visit LPA discussed the amendments with ED and the documents were signed and reviewed. No deficiencies were cited or observed on this date. An exit interview was conducted with Executive Director Jay Agustin who was provided with a copy of this report and Appeal Rights. Their signature confirms receipt of these documents.the state’s words, verbatim · CDSS document, Apr 10, 2026

Allegation investigated: Facility staff hit resident

Licensing Program Analyst (LPA) Jose De La Cruz conducted an unannounced visit regarding the above allegation. LPA was greeted by Executive Director Jay Agustin, to whom LPA identified as such and explained the purpose of the visit. The reporting party (RP) alleged that one resident (R1) was hit in the knee by facility staff. LPA contacted RP on March 27th, 2026. According to RP, staff member S1 reported the allegation after R1 left the facility for their day program and indicated that R1 was assessed on the same day, with no injuries or discoloration observed. RP stated that R1 did not repeat the allegation to RP. Additionally, an outside source familiar with R1 (OS1) believed that the injury was not caused by a staff member as R1 had provided conflicting accounts of the incident. [CONTINUED ON LIC9099-C] Unsubstantiated [CONTINUED FROM LIC9099] On the same date, LPA conducted an unannounced visit to the facility. R1’s records were reviewed which revealed a diagnosis of [INSERT dementia]. During the visit, LPA reviewed staff and resident files, incident reports, and interviewed staff involved. Per staff (S2 and the Executive Director), when R1 returned from the day program, R1 was physically assessed, and no injury, bruising, or bleeding was noted. When questioned about the allegation, R1 denied making any abuse allegations. On April 02, 2026, LPA interviewed R1’s day program staff member OS2, who initially received the allegation. OS2 corroborated the information provided by RP and reported that R1 had previously made statements such as “someone threw rocks at my head,” later correcting the statement to “it feels like somebody threw rocks at me.” On the same date, LPA conducted an additional unannounced visit to interview R1 and staff member S1, who reported the allegation. R1 was observed by LPA to be confused and disoriented, as they did not know the time, day, or year. R1 reported knee pain, however, they gave conflicting timelines and explanations, both inconsistent with abuse. S1 described the chain of events consistently with the statements provided by the Executive Director and S2 during the previous visit. Based on record reviews, LPA observations, and interviews conducted with RP, the alleged victim, facility staff, and day program staff, the preponderance of evidence standard has not been met. Therefore, the allegation is deemed unsubstantiated. No deficiencies were cited in accordance with the California Code of Regulations. Report and Appeal Rights were discussed with and provided to Executive Director Jay Agustin. Signature below confirms receipt.the state’s words, verbatim · CDSS document, Apr 2, 2026 · control 08-AS-20260325110835

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jose De La Cruz conducted an unannounced required Annual Inspection. LPA Lopez later arrived and joined the visit. The facility file was reviewed prior to the visit. LPAs identified themselves, were granted entry by Director Agustin. LPA discussed the purpose of the visit with Director Jay Agustin. According to the facility’s license, there may be a maximum of 32 residents, all of whom may be non-ambulatory in at any given time at the facility site. The facility is approved for 7 hospice, 4 bedridden, and a waiver approved for non-physicians to prescribe medications. During today’s inspection, the facility’s current census is 26 residents living at the facility. There were 25 residents present at the facility site during the inspection and one on day program. LPAs inspected the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and activities. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] The facility’s ambient internal temperature was comfortable and compliant, at 73 degrees(º) Fahrenheit (F). Hot water temperature at taps accessible to residents were also compliant: sink in restroom #1 delivered hot water at 105ºF; sink in restroom #2 delivered hot water at 105.3ºF; sink in restroom #3 delivered hot water at 105.1ºF. There was at least 2 days of perishable food, and at least 7 days of non-perishable food present. Cooking, dining equipment and utensils were present, and all safely stored. There were no toxic chemicals or poisons accessible to residents. Medications were properly labeled, as required, and stored in locked cart, which LPA inspected. The facility maintained medication logs, which LPA reviewed. No pools or bodies of water on the premises. Per administrator Agustin, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and the facility telephone were all working. Fire extinguishers were present (03) and serviced within the last 12 months. The first aid kit was complete and readily accessible. LPAs interviewed 2 staff and 5 residents, and reviewed staff and resident records. LPAs interviews did not raise any licensing concerns. The files that LPAs reviewed contained the required documents. Confidential records were stored in a locked area. Required licensing postings were observed in a visible area of the facility. There were no deficiencies observed or cited during today's annual inspection, but the facility received Technical Violation (TV) which may be found within this report. An exit interview was conducted with Administrator J Mhel Agustin, to whom a copy of this report, along with the Licensee/Appeal Rights (LIC9058 03/22), were provided at the conclusion of the visit. The signature below confirms that the documents were received.the state’s words, verbatim · CDSS document, Nov 20, 2025

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: POC

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced case management visit for a Plan of Correction clearance. LPA Lopez identified herself and was allowed entry by Shayla Martinez, Lead Caregiver. LPA met with Executive Director Jay Agustin and discussed the purpose of the visit. On 10/04/2024, the facility was issued deficiencies regarding the temperature of the hot water in various bathrooms, which did not comply with regulations, and resident files did not obtain updated copies of their Physician’s Report’s (LIC602s). During today’s visit, LPA measured the hot water temperature at taps and were all compliant: kitchen sink measured hot water at 108.5 degrees F; sink in restroom #1 delivered hot water at 108 degrees F; sink in restroom #2 delivered hot water at 110.7 degrees F; sink in restroom #3 delivered hot water at 107.2 degrees F; sink in restroom #4 delivered hot water at 111 degrees F; sink in restroom #5 delivered hot water at 110.8 degrees F; sink in restroom #6 delivered hot water at 110.3 degrees F; sink in restroom #7 delivered hot water at 109.9 degrees F; sink in restroom #8 delivered hot water at 113.9 degrees F; sink in restroom #9 delivered hot water at 113.7 degrees F; sink in restroom #10 delivered hot water at 113.4 degrees F; sink in restroom #11 delivered hot water at 114.1 degrees F; sink in restroom #12 delivered hot water at 115.3 degrees F; and sink in restroom #13 delivered hot water at 117 degrees F. The hot water temperatures were cleared throughout the facility. The LIC602s were all in the facility internal files and updated. As such, the deficiencies have been corrected and cleared during today’s visit. No deficiencies were observed during today's visit. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Executive Director Jay Agustin at the conclusion of the visit. The signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Oct 28, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required Annual Inspection. The facility file was reviewed prior to the visit. LPA Lopez identified herself, was granted entry by Assistant Administrator Richard Tibi. LPA discussed the purpose of the visit with Assistant Administrator Tibi. According to the facility’s license, there may be a maximum of 32 residents all of whom may be non-ambulatory in at any given time at the facility site. The facility is approved seven (7) hospice residents, and four (4) bedridden residents. They also have a waiver for non-physicians to prescribe medications. During today’s inspection, the facility’s current census is 24 residents living at the facility. There were 20 residents present at the facility site during the inspection. LPA, accompanied by Assistant Administrator Tibi, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and activities. The facility’s ambient internal temperature was comfortable and compliant, at 74 degrees Fahrenheit (F). Hot water temperature at taps accessible to clients were not all compliant: kitchen sink measured hot water at 115.2 degrees F; sink in restroom #1 delivered hot water at 116.4 degrees F; sink in restroom #2 delivered hot water at 116.4 degrees F; sink in restroom #3 delivered hot water at 116.2 degrees F; sink in restroom #4 delivered hot water at 116.4 degrees F; sink in restroom #5 delivered hot water at 115 degrees F; sink in restroom #6 delivered hot water at 113.9 degrees F; sink in restroom #7 delivered hot water at 126 degrees F; sink in restroom #8 delivered hot water at 127.8 degrees F; sink in restroom #9 delivered hot water at 125.8 degrees F; sink in restroom #10 delivered hot water at 124 degrees F; sink in restroom #11 delivered hot water at 123.4 degrees F; sink in restroom #12 delivered hot water at 125.8 degrees F; and sink in restroom #13 delivered hot water at 124.5 degrees F. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] There was at least 2 days of perishable food, and at least 7 days non-perishable food present. Cooking, dining equipment and utensils were present, and all safely stored in a locked kitchen area. There were no toxic chemicals or poisons accessible to residents. Medications were properly labeled, as required, and stored in locked cart. LPA inspected the medication cart and confirmed medications were properly labeled and stored. No pools or bodies of water on the premises. Per Assistant Administrator Tibi, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguishers were present (05) and serviced within the last 12 months. First aid kit was complete and readily accessible. LPA reviewed staff and resident records. During today’s visit there were 20 residents on the facility premise. LPA's inspection did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were stored in a locked area. Required licensing postings were observed in a visible area of the facility. Deficiencies observed and cited during today's annual inspection may be found on the LIC809-D page of this report. An exit interview was conducted with Assistant Administrator Richard Tibi to whom a copy of this report along with the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit. The signature below confirms the documents were received. LPA requested Assistant Administrator Tibi to submit a current Designation of Administrative Responsibility LIC 308, Personnel Report LIC 500, Emergency Disaster Plan LIC 610-E, and Residential Infection Control Plan LIC 9282 (6/23), to the licensing office within 10 business days. Forms are available at www.ccld.ca.gov.the state’s words, verbatim · CDSS document, Oct 4, 2024

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA), Carmen Lopez, conducted an unannounced visit to conduct a required annual inspection and in conjunction initiate this case management visit. LPA Lopez identified herself and was granted entry by Assistant Administrator Richard Tibi. LPA Lopez stated the purpose of the visit and reviewed the basic elements of the visit with Assistant Administrator Tibi. This visit was in response to an Unusual Incident/Injury Report (IR) that was received at the San Diego Regional Office on Wednesday, September 18, 2024. The IR stated that there was an incident that transpired on Saturday, September 14, 2024, with resident #1 (R1) who was transported to the hospital due to becoming weak. The facility notified the resident’s primary care physician (PCP) and their power of attorney (POA). During today's visit LPA Lopez toured the facility, spoke with staff, and requested and obtained relevant documents pertinent to this incident. LPA Lopez verified R1 was still in the hospital and was to return to the facility within the next two weeks. Staff said that they contacted the POA to notify them of the residents condition and they agreed to contact emergency personnel to have the resident transported to the hospital due to changes in their condition. According to records R1 had gone to the hospital days prior due to refusing meals. No deficiencies were cited during today’s visit. An exit interview was conducted with Assistant Administrator Tibi, and a copy of this report, LIC811 and Licensee Appeal Rights (LIC9058) were provided at the conclusion of the visit. The signature below confirms that the documents were received.the state’s words, verbatim · CDSS document, Oct 4, 2024

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA), Carmen Lopez, conducted an unannounced visit to initiate a case management visit. LPA Lopez identified herself and was granted entry by Sharon Hays, Activities Coordinator. LPA Lopez stated the purpose of the visit and reviewed the basic elements of the visit with Executive Director Jay Agustin. This visit was in response an Unusual Incident/Injury Report (UIR) that was received at the San Diego Regional Office on Thursday, August 1, 2024. Per the UIR the incident transpired on Tuesday, July 30, 2024, with resident #1 (R1) who eloped from the facility. During today's visit LPA Lopez spoke with staff and resident, and requested and obtained relevant documents pertinent to this incident. According to staff, the resident was last seen on the facility premise at around 11:40 AM prior to their mealtime which was between 12:00 PM and 12:15 PM. According to Executive Director, he last observed resident to be at the facility at around 11:40 AM prior to his departure. About 30 minutes later, he was contacted by the family who made him aware that the resident had eloped and was with law enforcement. Resident was returned to the facility the same day with no injuries. R1's Needs and Service Plan was discussed and updated with the family. Per the Executive Director, R1 recently moved-in on July 29, 2024. The Executive Director mentioned that staff conduct visual resident head counts during all mealtimes – three times and monitor during incontinence checks– at least about twice and/or on an as needed basis. Records confirmed that the resident’s move-in date was recent. The incontinence sheets, for 7/30/24, show R1 incontinence time was left blank along with four additional residents for the time frame in question, but per ED it was due to residents not needing incontinence assistance during that time frame. Residents Physician’s Report confirms that the resident is an elopement risk. In review of the residents file, the resident did not have an elopement plan in place. Per the residents Needs and Service Plan, the elopement risk was implemented into R1’s plan on 7/31/24. (Continuation on LIC809-C) (Continuation of LIC809) According to the Executive Director, as of 7/30/24, the facility implemented a meal check sheet for residents to be accounted for during their mealtimes and in-between times. The facility did conduct in-service training to all staff for elopement. A copy of the forms and training sheets were provided to LPA during the visit. Based in the information obtained during the visit, there is a deficiency being cited during today’s visit that may be found on the LIC809-D page of this report. An exit interview was conducted with Executive Director Jay Agustin, and a copy of this report, LIC811 and Licensee Appeal Rights (LIC9058) were provided to Executive Director Agustin, at the conclusion of the visit. The signature below confirms that the documents were received.the state’s words, verbatim · CDSS document, Aug 5, 2024

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.317 · Plan of correction due date: Aug 20, 2024

H&S 1569.317 Absentee notification plan for missing residents - Every residential care facility for the elderly, as defined in Section 1569.2, shall, for the purpose of addressing issues that arise when a resident is missing from the facility, develop and comply with an absentee notification plan as part of the written record of the care the resident will receive in the facility, as described in Section 1569.80. This requirement was not met as evidency by: Based on records review, the licensee did not provide an elopement plan to meet resident’s needs to R1, 1 of 23 residents in care, which posed a potential safety risk to persons in care.the state’s words, verbatim · CDSS document, Aug 5, 2024

Plan of correction: Executive Director will implement an elopement plan for R1, and have staff complete Relias training and submit a copy of R1s elopment plan and the staff certificates to LPA via email by POC due date, 8/20/24.

Allegation investigated: - Staff physically abused resident

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced visit to deliver findings for a complaint investigation. LPA investigated and delivered findings regarding the above-mentioned allegation. LPA identified herself and was granted entry by Sharon Hays, Activities Coordinator. LPA stated the purpose of the visit and reviewed the findings of the complaint with Executive Director Jay Agustine. The Department’s investigation consisted of interviews with staff, resident, and outside sources, and records review of relevant documents pertinent to this investigation. On April 18, 2024, it was alleged that the facility staff physically abused a resident. It was specifically alleged that the facility staff kicked resident on her back. Interview with resident #1 (R1) showed that they were confused as they first reported to LPA that it was hospital staff who pushed them. R1 later contradicted themselves and said that it was facility staff who had pushed them. R1 was unable to keep their conversation centralized to one topic during the interview. (Continuation on LIC9009-C) Unsubstantiated (Continuation of LIC9099) LPA attempted to redirect the conversation, but the resident was forgetful and would continuously change the conversation. Staff interviews confirmed that resident would unconsciously make-up stories and would believe that they were true. Staff said they would have to intervene and inform resident that everything would be fine so the residents emotional state would stabilize. LPA attempted to speak with the LTCO but was unable. Interview with outside source said they had no concerns with the staff, or the care being provided by the facility to their loved one. A review of records revealed that resident does have a diagnosis of loss of intellectual functioning. Their primary diagnosis on their Physician’s Report (LIC602), per WebMD’s definition, describes it as damage or disease that affects the brain that leads to an altered mental state, leaving a person confused and not acting like oneself. Their LIC602 does confirm that resident is confused and at times may not be able to follow instructions. R1 does not have the capacity to provide themselves self-care. Per their mental cognition, the resident is non-ambulatory. The resident care notes shows that the resident is in need of ADL assistance with preparing items for them and standby assist. They also require reminders. A review of incident reports (IR) revealed that resident does have a history of falls. On 4/15/24, resident was found confused on the floor and staff initiated emergency response. Resident was taken to the hospital and treated. Residents responsible party (RP) and primary care physician (PCP) were notified. Another IR, dated 01/10/2024, revealed that R1 had fallen, and emergency response was initiated and R1 was taken to the hospital to be treated. This incident caused R1 to fracture their left wrist. R1’s PCP and RP were notified of the incident. According to hospital notes, R1 had old, healed fractures to the wrist and swelling to the right knee. Their mental cognition raced from topic to topic and very disjointed thinking. R1 does use a walker and hospital staff would need to follow them closely with a wheelchair. Based on the Department’s investigation of the above-mentioned allegation and the evidence obtained during staff, resident and outside source interviews, records reviewed, and LPA observations, there is insufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegation is deemed to be unsubstantiated. The report was discussed, and an exit interview was conducted with Executive Director Jay Agustine. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) were provided to Executive Director Agustine at the conclusion of the visit. The signature below confirms the receipt of these documents.the state’s words, verbatim · CDSS document, Jul 22, 2024 · control 08-AS-20240418105131

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Carmen Lopez made an unannounced visit to the facility to deliver findings for complaint investigation and in conjunction conduct this case management visit. LPA identified herself and was granted entry by Sharon Hays, Activities Coordinator. LPA met with Executive Director Jay Agustine and discussed the purpose of today’s visit. During the complaint investigation, control # 08-AS-20240418105131, the following was discovered: on 04/18/2024, the San Diego Regional Office (SDRO) received an incident report (IR) for resident #1 (R1). The IR reported that on 04/15/2024 R1 was found on the floor at 9:00 AM. According to the report staff immediately initiated 911 where paramedics transported R1 to the hospital. Upon further review of facility records, the charting notes state that R1 had fallen twice on 4/15/2024 and emergency response was initiated two (2) hours after the initial fall due to staff being unable to speak with R1. According to the IR, R1 was confused, pale and very weak. Based on the evidence obtained during the complaint investigation, deficiencies were observed and being cited during today’s case management and may be reviewed on the LIC809-D page of this report. An exit interview was conducted, a plan of correction was jointly developed with Executive Director Jay Agustine. A copy of this report, LIC811 and the Licensee Rights (01/2016) were provided to Executive Director Agustine at the conclusion of the visit. The signature below serves as confirmation of receipt of these documents.the state’s words, verbatim · CDSS document, Jul 22, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(g) · Plan of correction due date: Aug 5, 2024

87465 Incidental Medical and Dental: (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). Based on records review the facility did not contact emergency personnel immediately after the initial fall and waited two hours to contact resident to be transported to the hospital which posed a potential health risk for 1 of 25 residents (R1) in care.the state’s words, verbatim · CDSS document, Jul 22, 2024

Plan of correction: Executive Director will update the SIR and conduct staff in-service training on RELIAS for Reporting Incidents for documenting special incident reports properly and submit in-service training sheet and certificates for med techs and ED to LPA via email, by POC due date of 08/05/2024.