Ocean Breeze at Blue Oak

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit. LPA initially met with facility staff, Cecilia Manuel. Administrator Evelyn Rayas was contacted and arrived shortly after the visit began. Entrance interview conducted. The LPA, along with Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: Fire extinguishers are fully charged and last serviced on 04/07/2025. Hardwired combination smoke detectors and fire doors were tested at 12:06 P.M., separate carbon monoxide detector was tested at 12:09 P.M. and all were functional at the time of the visit. No fire clearance concerns were observed. KITCHEN: The LPA observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of seven (7) days non-perishable and two (2) days perishable food as well as emergency food. Cleaning supplies are located in a locked cabinet under the kitchen sink. Knives and sharps are locked and properly stored in a separate kitchen drawer next to the dishwasher. COMMON AREAS: In the common areas, including the dining room and living room, walls and flooring were checked for cleanliness and good condition. At the time of the visit, the furniture was observed to be in good condition. The LPA observed the required postings in the common area. LPA observed the fireplace in the living room, which was adequately screened. Auditorial signals were observed in each door around the facility. The facility maintained a comfortable temperature of 71 degrees. Continued on LIC 809-C Continued from LIC 809 BATHROOMS: There are three (3) bathrooms for resident use. One (1) shared half bathroom was observed in the hallway, two (2) full bathrooms with walk-in showers are designated for resident use. Restrooms were observed to be equipped with slip-resistant surfaces and mats. Grab bars were observed in the bathrooms. The water temperature was measured in all three (3) bathrooms and initially measured between 100.8-103.5 degrees Fahrenheit; water heater temperature was adjusted during the visit. LPA observed a loose sink knob and a unsteady grab bar next to the toilet in the bathroom located between bedroom#1 and #2. Additionally, the bathroom between the kitchen and the family room has a broken towel holder. BEDROOMS: There are six (6) total bedrooms in the facility; five (5) bedrooms are designated for resident use. Four (4) are for single occupancy and one (1) is a shared room. LPA observed one (1) staff room which was locked at the time of the visit. All residents’ rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. GARAGE: Garage was observed locked and contained laundry area, extra food, PPE and incontinence supplies, and emergency food and water. Cleaning compounds were stored in cabinets surrounding the washer and dryer and separately from food supplies. OUTDOOR SPACE: The backyard has a covered patio area with patio furniture including a table and chairs for resident use. LPA observed two (2) side gates. During today’s visit, the self-latching mechanism on both side gates were inoperable. The administrator stated that the property owner was present on 09/02/2025 to assess these concerns and agreed to replace the larches on both gates. All passageways were observed to be clear. There were no bodies of water on the premises. Continued on LIC 809-C Continued on LIC 809-C RECORD REVIEW: Began at 12:28 P.M. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. LPA observed that two (2) out of six (6) resident files reviewed indicated that resident has no capability for self-care, and they are not on hospice, and there were no records indicating that an exception request was submitted to the department. All other required forms were complete. All five (5) staff files including the Administrator were observed to be in compliance with regulation. All training was observed to be complete. MEDICATION REVIEW: Medications are kept in a locked kitchen cabinet. Additionally, inside the locked cabinet facility has resident’s records and a complete First Aid kit with a manual. Began at 2:20 P.M. Medications for six (6) residents were observed. All medications observed were labeled, stored, and properly documented at the time of the visit. LPA obtained Client Roster, Staff Roster, and Liability insurance. Last emergency drill was conducted on 07/17/2025. LPA reviewed the facility’s Emergency Disaster Plan and the infection control plan. The plans were in compliance with regulations at the time of the visit. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 3, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit at 09:15 A.M. LPA initially met with facility staff, Gerardo Gonzalez. Administrator Evelyn Rayas was contacted and arrived shortly after the visit began. Entrance interview conducted. Beginning at 09:45 A.M., the LPA, along with Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: Fire extinguishers are fully charged and last serviced on 05/10/2024. Hardwired combination smoke detectors and fire doors were tested at 10:15 A.M., separate carbon monoxide detector was tested at 10:18 A.M. and all were functional at the time of the visit. No fire clearance concerns were observed. KITCHEN: The LPA observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of seven (7) days non-perishable and two (2) days perishable food as well as emergency food. Cleaning supplies are located in a locked cabinet under the kitchen sink. Knives and sharps are locked in a separate kitchen drawer next to the dishwasher. LPA observed them to be locked and properly stored at the time of the visit. At 9:52 A.M. hot water temperature measured at 117.9 degrees Fahrenheit. COMMON AREAS: In the common areas, including dining room and living room, walls and flooring were checked for cleanliness and good condition. At the time of the visit, furniture was observed to be in good condition. The LPA observed the required postings in the common area. LPA observed the fireplace in the living room, which was adequately screened. Auditorial signal was observed in each door around the facility. Facility maintained a comfortable temperature of 71 degrees. Continued on LIC 809-C Continued from LIC 809 BATHROOMS: There are three (3) bathrooms for resident use. One (1) shared half bathroom was observed in the hallway, two (2) full bathrooms with walk-in showeres are designated for resident use, Restrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed in the bathrooms. The water temperature was measured in all three (3) bathrooms and measured in compliance with regulation. BEDROOMS: There are six (6) total bedrooms in the facility; five (5) bedrooms are designated for resident use. Four (4) are for single occupancy and one (1) is a shared room. LPA observed one (1) staff room which was locked at the time of the visit. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. GARAGE: Garage was observed locked and contained laundry area, extra food, PPE and incontinence supplies, and emergency food and water. Cleaning compounds were stored in cabinets surrounding the washer and dryer and separately from food supplies. OUTDOOR SPACE: The backyard has a covered patio area with patio furniture including a table and chairs for resident use. Both side gates were observed with self-latching mechanism and operational at the time of the visit. All passageways were observed to be clear. There were no bodies of water on the premises. RECORD REVIEW: Began at 10:35 AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. All five (5) staff files including the Administrator and six (6) resident files observed were observed to be in compliance with regulation. All training was observed to be complete. Continued on LIC 809-C Continued from LIC 809-C MEDICATION REVIEW: Medications are kept in a locked kitchen cabinet. Additionally, inside the locked cabinet facility has resident’s records and a complete First Aid kit with a manual. Began at 12:15 P.M. Medications for six (6) residents were observed. All medications observed were labeled, stored, and properly documented at the time of the visit. INTERVIEWS: During today's visit, LPA interviewed two (2) staff and one (1) resident. LPA obtained Client Roster, Staff Roster, and Liability insurance. Last emergency drill was conducted on 07/05/2024. LPA reviewed facility’s Emergency Disaster Plan. Plan was in compliance with regulations at the time of the visit. No deficiencies cited at this time. Exit interview conducted. Report issued and provided to Administrator.the state’s words, verbatim · CDSS document, Oct 1, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 08:40AM. LPA initially met with facility staff. Administrator Evelyn Rayas was contacted and arrived shortly after the visit began. Entrance interview conducted. Beginning at 09:10AM, the LPA, along with Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: Fire extinguishers are fully charged and last serviced on 05/19/2023. Hardwired combination smoke detectors and fire doors were tested at 11:03AM, separate carbon monoxide detector was tested at 11:05AM and all were functional at the time of the visit. No fire clearance concerns were observed. KITCHEN: The LPA observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of seven (7) days non-perishable and two (2) days perishable food. Cleaning supplies are located in a locked cabinet under the kitchen sink. Medications and sharps are locked in a separate kitchen cabinet. Water was tested in the kitchen sink and measured in the appropriate range. COMMON AREAS: This includes the living room, family room, and dining room areas. LPA observed common area to be clean and properly furnished at the time of the visit. An adequately screened fireplace was noted in the living room. BATHROOMS: There are three (3) bathrooms for resident use. One (1) shared half bathroom was observed Report Continued on LIC 809-C in the hallway, one (1) full bathroom is designated for resident use, one (1) private bathroom was observed attached to the shared resident bedroom with an adjoining door to a private resident bedroom. It was observed that the facility staff are currently using the walk-in shower for all residents, not just the residents with direct access to the private restroom. Restrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed in the bathrooms. The water temperature was measured in both shared resident bathrooms and measured in compliance with regulation. BEDROOMS: There are six (6) total bedrooms in the facility; five (5) bedrooms are designated for resident use and one (1) staff room. The staff room is kept locked. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. GARAGE: Garage was observed locked and contained laundry area, extra food, PPE and incontinence supplies, and emergency food and water. OUTDOOR SPACE: The backyard has a covered patio area with patio furniture including a table and chairs for resident use. Facility has one gate, which was observed at 09:25AM to be difficult to open, not self-closing or self-latching. All passageways were observed to be clear. There were no bodies of water on the premises. RECORD REVIEW: Began at 09:30AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. All five (5) staff files and five (5) resident files observed were observed to be in compliance with regulation. Administrator Certificate was observed to be expired 03/22/2023, however LPA reviewed the Administrator Certification website, which indicated all documents were received 02/21/2023 and the Administrator's Certificate is still pending at this time. All trainings were observed to be complete. MEDICATION REVIEW: Began at 01:00PM. Medications for five (5) residents were observed. All medications observed were labeled, stored, and properly documented at the time of the visit. Report Continued on LIC 809-C INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly, with the last drill conducted on 07/14/2023. Emergency disaster plan was observed to be complete and updated annually, as required. INTERVIEWS: During today's visit, LPA interviewed two (2) staff and attempted to interview three (3) residents. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 6, 2023

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.