Blue Skies of Oceanside

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to caregiver Teresita Diaz. The facility's license shows a maximum capacity of six (6) residents of which can be one (1) ambulatory and five (5) non-ambulatory residents, ages 60 and over. During today’s inspection there were five (5) residents in care. LPA spoke with Licensees Hong Hanh Le Dao and Yann Coudronniere via phone and House Manager Lauren Delancey arrived later to the facility. LPA and Teresita 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, screens, 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 client activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Lauren, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed staff and clients, and reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. Deficiencies were cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D) regarding two (2) residents being bedridden without an approved clearance, and an unverified TB clearance for a caregiver. A Plan of Correction was jointly developed with the licensee. An exit interview was conducted with House Manager Lauren Delancy, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Jun 18, 2026

Type of visit: Required - 1 Year

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 Caregiver Leonor Gaya. LPA spoke with House Manager Lauren DeLancy via telephone during the visit. The facility is licensed for a maximum capacity of 6 residents, 5 of which may be non-ambulatory. As of 3/14/2024, the facility has a pending fire clearance request to increase the facility's capacity to 6 non-ambulatory residents, 1 of which may be bedridden. The facility also has a pending waiver request for 4 hospice residents. During today’s visit, the facility had a census of 5 non-ambulatory residents. The Administrator for the facility is Rafael Gamab and their certificate was valid and current. During today’s visit, LPA toured the facility and inspected each room of the facility, including resident and staff rooms, bathrooms for resident and staff use, kitchen, garage, common areas, and outside space. No bodies of water were observed on the premises. LPA did not observe any aspects of delayed egress or secured perimeter. The facility was found to be clean, safe, and in good repair with no pathway obstructions. The facility’s water temperature was measured at 107.6 and 107.8 degrees Fahrenheit in common bathrooms. The facility’s internal temperature was measured at 78 degrees Fahrenheit. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. LPA also observed locked storage for resident medications and resident and staff files. During the review of the locked medication cabinet, LPA observed the daily medications for all 5 residents were stored in a daily pill box. Interviews with staff revealed that the pill boxes only contained medications for that day. Continued on LIC809-C page… During the tour of the backyard, LPA did not observe any shaded area for resident use. Staff Gaya stated that there used to be tarps that were hung from the roof and poles that used to provide shade to the backyard but they were removed. 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 44 degrees Fahrenheit, and the facility freezer was kept at 0 degrees Fahrenheit. LPA observed linens and hygiene products provided to the residents that are in good repair and sufficient to meet their needs. According to Leonor Gaya, no firearms or weapons are stored on the premises. Staff present at the facility during the time of the inspection had a criminal background clearance, were associated to the facility, and had a first aid certificate. LPA reviewed multiple resident and staff records. Each resident record was complete and contained a signed admission agreement, initial medical assessment, updated annual reappraisal, documents regarding safeguarding personal property and personal rights. Each staff file was complete and contained a personnel record, first aid certificate, fingerprint clearance and association, and a health screening. LPA was away from the facility for approximately one hour between 11:50am and 12:50pm. The following two deficiencies were cited for medications not stored in their original container and not having a shaded outdoor area and are noted on the attached LIC809-D page. An exit interview was conducted with Caregiver Leonor Gaya, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Jun 30, 2025

Allegation investigated: Lack of care resulting in serious injury. Staff did not provide incontinence care.

Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced complaint investigation visit to deliver findings. LPA Silveira introduced themselves, met with Caregiver Leonor Gaya and disclosed the purpose of the visit. The Department’s investigation consisted of observations and interviews. It was alleged that Resident #1 (R1) suffered a fractured vertebrae while in care at Blue Skies of Oceanside in October of 2021. It was also alleged that R1 was left in soiled clothing for extended periods of time during this same timeframe at Blue Skies of Oceanside. LPA observations from a facility visit conducted on 11/19/21 revealed that R1 did not reside at Blue Skies of Oceanside. An interview with the Administrator on 11/19/21 also revealed that R1 used to reside at Blue Skies of Oceanside, but was transferred to sister facility Blue Skies of San Marcos in October of 2021 to be closer to family. (CONTINUED ON NEXT PAGE, LIC 9099-C) Unfounded Department interviews conducted with staff and outside sources also revealed that during the time of the alleged incidents, which allegedly took place in October of 2021, R1 resided at Blue Skies of San Marcos. Based on the Department’s investigation of the above-mentioned allegations and the evidence obtained from observations and interviews, we have found that the complaint was unfounded. An unfounded determination means that the allegation was false, could not have happened and/or is without a reasonable basis. The allegations were not pertinent to this licensed facility. The report was discussed, and an exit interview was conducted with Caregiver Leonor Gaya. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) was provided to Leonor at the conclusion of the visit. The signature below confirms the receipt of these documents.the state’s words, verbatim · CDSS document, Apr 30, 2024 · control 08-AS-20211115114750

Type of visit: Collateral

Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced collateral visit to conduct a resident interview. The LPA introduced himself to Caregiver Jemela Magulod, and disclosed to the purpose of the visit. Review of records and an interview with Magulod revealed Resident # 1 (R1) did not reside at the facility. An exit interview was conducted with Caregiver Magulod, to whom a copy of this report, and Licensee/Appeal Rights, were provided.the state’s words, verbatim · CDSS document, Apr 10, 2024

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced complaint visit to amend a Complaint Investigation Findings report (LIC 9099). LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Leonor Gaya. During today’s visit, LPA amended a Complaint Investigation Findings Report (LIC 9099), dated 02/28/24, for a complaint filed on 11/15/21. The report findings were changed to UNFOUNDED. The findings were changed to unfounded because the dates of the alleged incidents for the resident mentioned in the complaint, were for dates that the resident lived at sister facility Blue Skies of San Marcos (facility #374604305). An exit interview was conducted with Caregiver Leonor Gaya, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Mar 22, 2024

Type of visit: Required - 1 Year

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 Caregiver Leonor Gaya. The facility is licensed for a maximum capacity of 6 residents, 5 of which may be non-ambulatory. The facility has a waiver for 3 hospice residents. During today’s visit, the facility had a census of 6 residents, all of which were non-ambulatory. The facility also had 4 residents receiving hospice services. LPA did not observe any aspects of delayed egress or secured perimeter. The Administrator for the facility is Rafael Gamab and their certificate was valid and current. During today’s visit, LPA toured the facility and inspected each room of the facility, including resident and staff rooms, bathrooms for resident and staff use, kitchen, garage, common areas, and outside space. No bodies of water were observed on the premises. The facility was found to be clean, safe, and in good repair with no pathway obstructions. The facility’s water temperature was measured at 134.4 degrees Fahrenheit in a common bathroom. Caregiver Leonor Gaya turned the water heater down and the water temperature was measured at 118.2 degrees Fahrenheit in the same bathroom. The facility’s internal temperature was measured at 73 degrees Fahrenheit. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. According to Leonor Gaya, no firearms or weapons are stored on the premises. LPA also observed locked storage for resident medications and resident and staff files. LPA observed pillboxes for 6 residents which contained the medication doses for the noon, pm, and bedtime medication passes for all 6 residents. LPA observed 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 45 degrees Fahrenheit, and the facility freezer was kept at 0 degrees Fahrenheit. Continued on LIC809-C page… LPA observed linens and hygiene products provided to the residents that are in good repair and sufficient to meet their needs. Staff present at the facility during the time of the inspection had a criminal background clearance, were associated to the facility, and had a first aid certificate. 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. Each staff file was complete and contained a personnel record, first aid certificate, fingerprint clearance and association, and a health screening. LPA spoke with staff and residents present at the facility during the time of the inspection and those interviews did not reveal any licensing or regulatory concerns. The Administrator will submit copies of the LIC500 Personnel Report, LIC610E Disaster Plan, and current liability insurance to the Department within 15 business days. The following deficiencies for fire clearance, hospice waivers, medications, and hot water temperature were cited per California Code of Regulations Title 22 and noted on the attached LIC809-D pages. Additionally, a civil penalty for the fire clearance in the amount of $500 is being issued on an LIC421IM. An exit interview was conducted with House Manager Lauren di Lantis via phone and Caregiver Leonor Gaya, whose signature below confirms receipt of a copy of this report, the LIC421IM, and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Mar 14, 2024

Allegation investigated: Staff did not allow residents to have visitors

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Caregiver Leonor Gaya. During today's visit, LPA observed residents in care and obtained copies of facility records. The Department’s investigation consisted of interviews with residents, staff, and outside sources, records review, and a tour of the facility. It was alleged that staff did not allow residents to have visitors. Interviews and review of recent medical assessment revealed that Resident 1 (R1) had a diagnosis of major cognitive impairment, was confused and disoriented, and was unable to follow directions or make their needs known. [Caregiver was provided with an LIC811 Confidential Names list to identify R1]. Continued on LIC9099-C page... Substantiated Interviews with residents, staff, and outside sources revealed that due to an outside dispute, facility staff were instructed by outside parties to deny R1 visitation with Outside Party 1 (OP1). Interviews revealed that OP1 was denied visitation with R1 on multiple occasions and that, at the time of when the Department received the complaint, there was no legal order restricting OP1’s ability to visit with R1. Interviews were not able to confirm if R1 had been asked if R1 wanted to see or visit with OP1. Review of a document regarding visitation for R1 revealed that outside parties requested that facility staff restrict visitation to only approved individuals. Interviews did not reveal that staff prevented the visitation of any other residents or outside parties. The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has been met, therefore, this allegation is deemed substantiated. The following deficiency is cited per CA Code of Regulations Title 22 and noted on the attached LIC9099-D page. An exit interview was conducted with House Manager Lauren deLantis via telephone and Caregiver Leonor Gaya, whose signature below confirms receipt of a copy of this report, LIC811, and the Licensee Appeal Rights (LIC9058 03/22). Interviews and records review revealed that after the fall, R1 was prescribed a mediation for pain relief on an as needed basis. Interviews revealed that the pain medication caused R1 to experience drowsiness as a side effect and staff stopped giving R1 that pain medication as a result. Interviews did not reveal any concerns regarding R1’s pain management or overmedication. Interviews with staff and outside parties denied any instances of R1 or any other residents being overmedicated by facility staff. 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 Caregiver Leonor Gaya, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 03/22).the state’s words, verbatim · CDSS document, Feb 29, 2024 · control 08-AS-20240110105212

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(11) · Plan of correction due date: Mar 8, 2024

87468.1 (a)(11) To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice... This requirement has not been met as evidenced by: Based on interviews and records review, the Licensee did comply with the section above due to staff restricting OP1 from visiting with R1. This poses a potential personal rights risk to 6 of 6 residents.the state’s words, verbatim · CDSS document, Feb 29, 2024

Plan of correction: The House Manager stated that staff will allow visitation for all residents and staff will receive in-service training and submit copies of the sign in sheet to the Department by POC due date of 3/8/24.