Carlsbad by the Sea

Type of visit: Annual/Random

Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced Annual visit. LPA met with Med Tech Alex and we discussed the purpose of the visit, Tamara Movsisyan, Director of Health Services joined joined the annual visit to assist with resident and staff files. The Executive Director, Paula Digerness, also joined the annual visit The facility file was reviewed before the visit. According to the facility’s license, the facility's license shows a maximum capacity of 224 residents over the age of 60, of which 208 may be non-ambulatory. Hospice waiver for 5. During today’s inspection there were 190 residents in care. The facility was assessed by touring it inside and out. LPA inspected for compliance with safety, maintenance, and operational requirements. LPA interviewed staff, and residents in assisted and independent living. There are no firearms stored on the premises. There were two areas available for dining, the meals are prepared in the main dining area for all residents living in the property. There were at least two (2) days of perishable food, and at least seven (7) days of non-perishable food present, all safely stored in the kitchen inspected. Cooking/dining equipment and utensils were present. The kitchen and dining areas were clean, organized, and free from bad odors. Fresh fruit and vegetables were observed to be of good quality. There was a facility pool, and LPA toured the area with Tamara and Paula A key fob restricted access to the pool and the four (4) doors were secured during the LPA's visit. Today's inspection consisted of parts within each of the three buildings. LPA inspected the nursing station; resident records and medication were observed to be secured and locked as required. Per staff, the hot water temperature was measured by maintenance once a week. (continue at LIC809C) (Continue from LIC809) LPA observed smoke alarms present in each room. The appliances in the resident rooms were in working order. Each room observed was clean, sanitary, and in good operating condition. Temperature in the residents' rooms was controlled by each resident. It was also observed pull cords in each of the residents' rooms. All bathrooms inspected had grab bars installed in the shower areas. However, there was one bathroom observed that did not have grab bars by the toilet. Cleaning supplies for the housekeeping staff were secured in the housekeeping closet. The signal system was tested in the presence of staff; staff responded in less than one (1) minute. Some of the residents also utilize a pendant that can be worn to request staff assistance in emergencies. No concerns regarding response times. Medications were labeled, as required, and stored in locked areas. LPA observed several medication carts that were locked and secured. In independent living, all residents keep their medications in their apartments. Keys to the medication were kept and controlled by appropriate staff with responsibility for medication management for assisted living. LPA interviewed staff and reviewed multiple staff and resident records/files. LPA interviews did not raise any licensing concerns. The files that LPA reviewed contained the required documents. Confidential records were stored in locked areas. Facility staff conducted emergency drills at least quarterly in some cases every two (2) months. Fire drills were conducted each month. The facility updated its disaster and emergency preparedness plan. Staff had current basic first aid and basic CPR certificates on file. Required training was current and complete for all staff records reviewed. All required postings were observed to be prominently displayed in common areas of the facility. All fire extinguishers were serviced within this last year. No deficiencies during this annual visit. An exit interview was conducted with the xxx to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Aug 29, 2026

Allegation investigated: Staff do not allow resident to leave their room. Staff interfering with resident sleeping. Staff does not let resident leave the facility. Staff not providing records to authorized. Facility charging for services that were not approved by resident or agents.

Licensing Program Analyst (LPA) Sarah Hurt to deliver findings on the allegations listed above. LPA met by phone with Executive Director Paula Digerness and explained the purpose of today's visit. Regarding the allegation -Staff do not allow resident to leave their room. The Department reviewed Resident 1's Health and Wellness Review dated February 24, 2022, service plan documentation, and related correspondence. Interviews were conducted to the extent possible; however, due to the passage of time, recollection of specific events was limited. Records reviewed document the resident required frequent supervision, prompting, and redirection related to cognitive impairment and safety awareness. Documentation reflects the resident required wellness checks three to four times daily, which included checking overall wellness and safety, removal of spoiled food, and trash disposal. These checks did not include hands-on assistance with activities of daily living and were not documented as restrictive in nature.Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated Unsubstantiated Regarding the allegation staff interfering with resident sleeping. The Department reviewed assessment records and service plan documentation. The Health and Wellness Review reflects the resident required scheduled medication administration three times daily, including an early morning medication at approximately 5:00 a.m., as well as wellness checks for safety. Due to the age of the complaint, interviews conducted were unable to provide specific details regarding alleged sleep disruption. No documentation was obtained indicating staff intentionally deprived the resident of sleep or conducted unnecessary room entries outside of documented care needs. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated Regarding the allegation Staff does not let resident leave the facility. The Department reviewed facility records and assessment documentation. Records reflect the resident was ambulatory, transferred independently, and participated in activities. Documentation does not indicate the resident was restricted from leaving the facility or placed under involuntary confinement. Interviews conducted did not provide consistent or sufficient information to corroborate that the resident was prevented from leaving the facility. Due to the passage of time, specific recollections were limited. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Regarding the allegation Staff not providing records to authorized. The Department reviewed available documentation and correspondence. No records were obtained demonstrating that the facility refused to provide requested records. Interviews conducted did not provide documentation or consistent statements confirming that records were requested and denied. Due to the age of the complaint, the Department was unable to verify the nature or timing of any alleged records requests. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated Regarding the allegation facility charging for services that were not approved by resident or agents. Investigation: The Department reviewed service plan documentation and assessment records. The Health and Wellness Review documents the resident’s service plan level and assessed care needs. No documentation was obtained demonstrating unauthorized charges or billing for services outside of the documented service plan. Interviews conducted did not provide sufficient or consistent information to substantiate unauthorized charges. Due to the passage of time, the Department was unable to obtain billing records documenting invoices during this time period.. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated Exit interview conducted with Executive Director Paula Digerness, and copy of report provided.the state’s words, verbatim · CDSS document, Feb 19, 2026 · control 08-AS-20220415090957

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was greeted by, identified themselves to and discussed the purpose of the visit with Executive Director Paula Digerness. The facility's license shows a maximum capacity of 224 residents over the age of 60, of which 208 may be non-ambulatory. Hospice waiver for 5. During today’s inspection there were 190 residents in care. LPA with Executive Director Digerness toured the interior and exterior of the facility, and inspected a sample of rooms. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, screens, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident 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 residents. Medications were labeled, as required, and stored in locked areas. There was an outdoor pool securely fenced and is only accessible to independent residents. Per Executive Director Digerness, 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 was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. No deficiencies were cited during the inspection. An exit interview was conducted with Executive Director Digerness to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Aug 28, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Executive Director Paula Digerness Today's visit was in response to an LIC624 Incident Report, which licensee self submitted to the CCLD San Diego Regional Office. According to the LIC624: on 10/08/24, Resident 1 (R1) [See LIC 811 Confidential Names List for a description of R1.] was diagnosed with a closed compression fracture of L5. LPA Domingo reviewed an incident report filed on 10/03/24 by Tamara Movsisyan RN that addressed R1's initial fall. R1 was sent out to the hospital for an evaluation on 10/1/24 due to the fall. R1's Primary Care Physician was notified. R1's family members were also notified. When R1 returned to the facility the staff followed up with a fall assessment and an increase in level of care due to the fall. On 10/8/24 R1's primary care physician provided a status post hospital visit follow up and determined that R1 needed to return to the hospital for further evaluation. The facility has followed up on R1's fall and is following the facility protocol on falls. LPA briefly toured the facility, performed a welfare check on residents in care, interviewed staff, and obtained copies of pertinent facility records. No immediate health or safety risks were observed and no deficiencies were cited during this visit. An exit interview was conducted, and a copy of this report and Licensee Rights LIC 9058 (03/22) were left with the Executive Director, whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Oct 17, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced Annual visit. LPA met with Executive Director, Paula Digerness and we discussed the purpose of the visit. Digerness is the certified administrator for the facility, and her Administrator's Certificate expires on June 17, 2025. The facility file was reviewed before the visit. According to the facility’s license, the community serves residents over age 60. 208 residents may be non-ambulatory. The property includes three (3) buildings, at 2807 Ocean Street, at 201 Grand Avenue, and the Main Building located at 2855 Carlsbad Blvd. A waiver is approved for five (5) hospice residents. Currently, there is only one (1) resident under hospice care living in assisted living. The facility was assessed by touring it inside and out. LPA inspected for compliance with safety, maintenance, and operational requirements. LPA interviewed staff, and residents in assisted and independent living. LPA briefly interacted with residents in care. All facility staff records reviewed by the LPA had a current criminal record clearance. Digerness stated there are no firearms stored on the premises. There were two areas available for dining, the meals are prepared in the main dining area for all residents living in the property. There were at least two (2) days of perishable food, and at least seven (7) days of non-perishable food present, all safely stored in the kitchen inspected. Cooking/dining equipment and utensils were present. The kitchen and dining areas were clean, organized, and free from bad odors. Fresh fruit and vegetables were observed to be of good quality. There was a facility pool, and LPA toured the area with Executive Assistant, Page Kerr. A key fob restricted access to the pool and the four (4) doors were secured during the LPA's visit. Today's inspection consisted of parts within each of the three buildings. LPA inspected the nursing station; resident records and medication were observed to be secured and locked as required. Per staff, the hot water temperature was measured by maintenance once a week. (continue at LIC809C) (Continue from LIC809) LPA observed smoke alarms present in each room. The appliances in the resident rooms were in working order. Each room observed was clean, sanitary, and in good operating condition. Temperature in the residents' rooms was controlled by each resident. It was also observed pull cords in each of the residents' rooms. All bathrooms inspected had grab bars installed in the shower areas. However, there was one bathroom observed that did not have grab bars by the toilet. LPA provided technical advice regarding grab bars by the toilets. Cleaning supplies for the housekeeping staff were secured in the housekeeping closet. The signal system was tested in the presence of staff; staff responded in less than one (1) minute. Some of the residents also utilize a pendant that can be worn to request staff assistance in emergencies. Per resident interviews, staff responded to the pendant in less than 5 – 10 minutes. Medications were labeled, as required, and stored in locked areas. LPA observed several medication carts that were locked and secured. In independent living, all residents keep their medications in their apartments. Keys to the medication were kept and controlled by appropriate staff with responsibility for medication management for assisted living. LPA interviewed staff and reviewed multiple staff and resident records/files. LPA interviews did not raise any licensing concerns. The files that LPA reviewed contained the required documents. Confidential records were stored in locked areas. Facility staff conducted emergency drills in April 2024, LPA verified that emergency drills were conducted at least quarterly in some cases every two (2) months. Fire drills were conducted each month. The facility updated its disaster and emergency preparedness plan was updated on April 15, 2024. Liability insurance was current until January 1, 2025. Staff had current basic first aid and basic CPR certificates on file. Required training was current and complete for all staff records reviewed. All required postings were observed to be prominently displayed in common areas of the facility. All fire extinguishers were serviced in April 2024. No Violations were observed during today's visit. An exit interview was conducted with the Executive Director, Digerness, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, May 29, 2024

Allegation investigated: Licensee did not timely refund advance fees, as required.

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to commence a complaint investigation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Executive Director Paula Digerness and Executive Assistant Paige Kerr. The Complianant alleged that after Resident #1 (R1) passed away, Licensee did not timely refund rent monies which R1 previously paid in advance, and which were now due to R1’s estate. CCLD’s investigation involved an unannounced facility tour, review of pertinent billing, care, and administrative records and E-mails, and interviews of relevant facility staff and outside sources. Interviews and records unanimously showed: R1’s responsible person (RP) signed R1’s admissions agreement when R1 first moved into the facility in 2020. On 03/04/2024, R1 passed away at the facility under hospice care. On 03/05/2024, RP vacated R1’s room of personal belongings and relinquished R1’s room to facility management. [CONTINUED ON LIC 9099-C] Substantiated [CONTINUED FROM LIC 9099] Before R1 died, they had prepaid their rent through 03/31/2024. The dollar amount of R1’s March 2024 rent, which they prepaid but did not fully use/expend, is not currently under dispute by any party. According to facility manager interviews and E-mails: As of the commencement of CCLD’s investigation on 04/29/2024, R1’s refund had not yet been disbursed to either R1’s estate or RP, due to outstanding/unpaid balance which R1 had previously incurred at Licensee’s skilled nursing facility (SNF). However, R1’s admissions agreement together with facility billing records showed that the final amount which Licensee charged (and which R1 paid before they died) was expressly for R1’s March 2024 assisted living stay, and not for skilled nursing / healthcare fees. Per regulation, Licensee was required to issue/disburse the refund to R1’s estate within 15 days of their bedroom being vacated of belongings, irrespective of whatever separate business R1 had with Licensee’s SNF facility. Interviews and records aligned to show that this requirement was not met. Based on records and interviews, a preponderance of evidence exists to show that Licensee did not timely refund advance fees, as required. One (1) deficiency was cited per California Health and Safety Code (refer to the attached LIC 9099-D). A Plan of Correction was jointly developed with the Licensee. An exit interview was conducted with Digerness and Kerr, to whom a copy of this report, the LIC 9099-D, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Apr 29, 2024 · control 08-AS-20240426131903

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652 · Plan of correction due date: May 3, 2024

1569.652 Termination of Admission agreement upon death of resident, etc.: “(c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees, or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the property is removed.” This requirement was not met, as evidenced by: Based on records and interviews, for 1 of 201 residents (R1), Licensee did not refund fees paid in advance, covering the time after R1 died and their personal property was removed from the facility, to R1’s estate within 15 days. This posed a potential personal rights violation to residents in care.the state’s words, verbatim · CDSS document, Apr 29, 2024

Plan of correction: Licensee agreed to immediately issue a check (either electronic or paper) for $7,626.25. This payment may be made to either R1’s estate or to RP (depending on Licensee’s internal process requirements). Licensee agreed to E-mail proof of payment disbursement to LPA, by the POC due date.