Ocean Breeze Care Home III

Allegation investigated: Staff restrain resident while in care. Facility did not follow reporting requirements.

On 08/07/2026, between 08:30 AM and 01:30 PM, Licensing Program Analyst (LPA) Troy Watson conducted an initial complaint visit to the facility listed above. LPA met with House Manager Jessica Hall and explained the purpose of the visit. LPA Watson was granted entry into the facility. The investigation consisted of the following: On 01/30/2026, the department requested and obtained the following documentation: Register of Facility Residents, Staff Schedule, Medication Administration Record for R1, Staff Trainings, Physician’s Report for R1, Hospital Admission Record for R1, Residential Appraisal for R1, Hospice Care medication list, and Durable Medical Equipment document for R1. The department interviewed Staff #1–Staff #3 (S1–S3) and Residents #2–#6 (R2–R6). An attempt to interview Resident #1 (R1) was made; however, R1 was no longer living at the facility at the time of the complaint visit. CONTINUED ON LIC9099-C Substantiated Allegation: Staff restrain residents while in care. It is alleged that the facility restrains a resident in care without authorization from family or a physician. On 01/30/2026, the department interviewed Administrator Staff #1 (S1), Gregg MacEllven. During this interview, S1 was asked whether staff restrain residents while in care. S1 stated that staff do not restrain residents. S1 reported that R1 utilized a harness while seated in a wheelchair to help keep R1 upright due to paralysis on the right side of their body following a previous stroke. S1 also reported that the harness buckle was repaired while the resident was admitted to the hospital. The department requested but did not obtain documentation showing a doctor’s order or approval for R1 to use a manual restraint as a postural support while in care. The department interviewed Staff #1–#(S1–S3) and Residents #2–#6 (R2–R6). Out of those interviewed, 3 out of 3 staff and 5 out of 6 residents denied the above allegation.Based on interviews conducted, the preponderance of evidence standard has been met. Therefore, the above allegation, Staff restrain resident while in care, is found to be Substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are cited on the attached LIC9099D. Deficiencies were issued and plans of correction were discussed. Note: Citations not cleared by the due date will result in a $100 fine assessed for each citation until cleared. Civil penalties will continue to accrue until Proof of Correction (POC) is cleared. Allegation: Facility did not follow reporting requirements. It is alleged that the facility failed to follow required reporting procedures for incidents involving residents. The department conducted an interview with Staff#1 (S1) and S1 was asked whether the facility follows the reporting requirements mandated by the California Department of Social Services. S1 stated that the facility does comply with reporting requirements. CONTINUED ON LIC9099-C Regarding the fall incident on 01/19/2026, S1 reported that after noticing a lump on the resident, she immediately contacted the resident’s authorized representative and transported the resident to the hospital. S1 stated the authorized representative met her at the hospital approximately one hour later and assisted with verbal translation for the physician. S1 reported the resident was admitted to the hospital from 01/19/2026 to 01/23/2026. S1 also stated that the resident had experienced prior falls at home before being admitted to the facility and had previously been sent to Sea Crest Hospital due to those incidents. S1 reported discussing the incident with staff and reviewing supervision needs following the fall, noting that the resident “did not fall out of their wheelchair hard, but it was just a soft roll onto the carpet, resulting in no major injuries.” The department interviewed Staff #1–#3 (S1–S3) and Residents #2–#6 (R2–R6). The department requested but did not obtain records showing that an Unusual Incident Report was submitted to Licensing due to R1 experiencing a fall at the facility and being admitted to the hospital as a result. As stated in Title 22, whenever an incident at the facility involves a resident’s health and safety and presents a potential risk, a report is required within 7 days of the occurrence. The department interviewed Staff #1–#3 (S1–S3) and Residents #2–#6 (R2–R6). Out of those interviewed, 3 out of 3 staff and 5 out of 6 residents denied the above allegation. Based on interviews conducted, the preponderance of evidence standard has been met. Therefore, the above allegation, Facility did not follow reporting requirements, is found to be Substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are cited on the attached LIC 9099D. Deficiencies were issued and plans of correction were discussed. Note: Citations not cleared by the due date will result in a $100 fine assessed for each citation until cleared. Civil penalties will continue to accrue until Proof of Correction (POC) is cleared. An exit interview was conducted with Administrator Gregg MacElven, and a copy of this report was provided. Allegation: Facility does not have enough staff. It is alleged that the facility has not employed enough staff to adequately monitor and care for residents, resulting in a resident experiencing a fall at the facility. On 01/30/2026, the department interviewed Administrator Greg MacEllven (S1). S1 was asked if the facility has enough staff, and S1 stated yes. Regarding the fall incident, S1 reported that the staff assigned to the resident was in the bathroom assisting another client with a bowel movement. S1 stated that staff heard the fall, responded immediately, assisted R1 back into their chair, assessed R1’s coherency, and notified the physical therapist, who then conducted an additional assessment. The department interviewed Staff #1–#3 (S1–S3) and Residents #2–#6 (R2–R6). Out of those interviewed, 3 out of 3 staff and 5 out of 6 residents denied the above allegation. The department obtained and reviewed the staff roster, which showed that the facility had enough trained staff available to adequately care for and monitor the residents in care. The department interviewed Staff #1–#3 (S1–S3) and Residents #2–#6 (R2–R6). Out of those interviewed, 3 out of 3 staff and 5 out of 6 residents denied the above allegation. Based on the information gathered, interviews conducted, and review of records, no evidence was found to support the allegation. Although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is Unsubstantiated. An exit interview was conducted with House Manager Jessica Hall, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 7, 2026 · control 11-AS-20260126152036

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(3) · Plan of correction due date: Aug 14, 2026

87608 Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement was not met as evidenced by: Based on interviews conducted and records reviewed, S1 acknowledged that a harness was placed on R1 since being admitted to the facility. The licensee did not have a physician’s order for Postural Supports. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 7, 2026

Plan of correction: The licensee agreed to conduct an in service training for all staff on section cited and residents personal rights. The licensee shall submit to the department a copy of the sign in sheet, and training materials, by the POC due date via email to troy.watson@dss.ca.gov

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(B) · Plan of correction due date: Aug 14, 2026

87211Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require…(1) A written report shall be submitted to…the person responsible for the resident within seven days of the occurrence of any of the events specified…below…(B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision. This requirement is not met as evidenced by: Based on interviews, the licensee failed to submit a complete written report to (R1’s) responsible person (W1) regarding (R1’s) fall and hip fracture. This violation poses a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 7, 2026

Plan of correction: The Licensee/Administrator agrees to: 1. Submit a complete written incident report containing all required elements for R1’s injury. 2. Conduct staff training on proper incident reporting procedures, including timelines and required documentation. 3. Provide a written statement to the Department confirming completion of corrective actions by the due date. Submit POC to: Troy.Watson@dss.ca.gov

Type of visit: Required - 1 Year

On 07/02/26, the department conducted an unannounced annual required inspection visit using the CARE Inspection Tool. The department met with the Administrator, Gregg MacEllven, and the purpose of the visit was explained. The department was granted access to the facility. The facility is licensed to operate for (6) non-ambulatory elderly adults aged 60 and above. The facility is approved for one (2) hospice waiver. Currently, there are (2) hospice residents in care. The facility is a single-story home located in a residential neighborhood. It consists of the following: six (6) private rooms, one (1) staff room, two (2) bathrooms, a living area, a dining area, a kitchen, an office, a laundry area, and an outside patio area. All bedrooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Bathroom toilets and water faucets worked properly, shower was free of mold/mildew, and there are sufficient toiletries accessible to residents. The water temperature properly measured between 105-120 F. A supply of perishable and non-perishable food was observed, toxins and knifes were stored and inaccessible to residents, no weapons nor bodies of water on the premises, exits and walkways are free of debris/hazards. The department conducted a review of six (6) residents records, six (6) Resident Medication Administration Records (MAR) and three (3) staff records and observed them to be complete and in order. First aid kit observed along with manual, fire extinguishers were fully charged, carbon monoxide and smoke detectors were operational, and the last fire/emergency drill was completed on 03/03/26. Facility fees are current; liability insurance is active (Identity Insurance Services Policy #ISCAH00000319-00 exp. 02/24/27). No deficiencies were cited during this inspection. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 2, 2026

Type of visit: Required - 1 Year

On August 6, 2025, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Administrator Gregg MacEllven. LPA explained the purpose of today’s visit. The facility is licensed to operate for (6) non-ambulatory elderly adults aged 60 and above. The facility is approved for one (2) hospice waiver. Currently, there are (2) hospice residents in care. The facility is a single-story home located in a residential neighborhood. It consists of the following: six (6) private rooms, one (1) staff room, two (2) bathrooms, a living area, a dining area, a kitchen, an office, a laundry area, and an outside patio area. LPA toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage of the resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of the visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. A water temperature of 115.9 degrees F. A comfortable temperature of 75 degrees F. was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished during the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available and maintained adequately. The fire extinguishers were charged, and smoke detectors and carbon monoxide were operable. Evaluation Report Continues on LIC 809-C A review of Medication Records Administration (MAR) are maintained in order and accurate. The facility conducted Fire/Safety Drill on March 6, 2025. The facility has a working landline telephone. The staff have all the current CPR/First Aid Training on file. During the visit, LPA observed the facility's infection control practices. LPA observed staff following screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). Posters mandated for inspection control were posted. An audit of residents #1-#5 (R1-R5) service records and staff #1-#3 (S1-S3) personnel records revealed to be complete. The facility has current liability insurance effective policy #PC19145181-02 effective 12/12/24 – 12/12/25. The facility is current on CCL annual dues. The facility has a current administrator's certificate for Gregg MacEllven #7012185740 effective 06/09/24 through 06/08/26 No deficiencies cited during this inspection visit. An exit interview conducted with Gregg MacEllven and a copy of the report is provided.the state’s words, verbatim · CDSS document, Aug 6, 2025

Type of visit: Required - 1 Year

On 6/14/2024, Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Gregg McEllven /Administrator. LPA explained the purpose of today’s visit. The facility is licensed to serve (6) elderly adults ages 60 and above, of which (6) can be non-ambulatory. The facility has an approved hospice waiver for (2). Facility is a (7) bedroom, one (2) full bathroom, single story house with small front porch with small ramp, stairs on east side of facility, back covered porch with ramp, and attached 2 car garage. The facility is a orange stucco with wood structure and small backyard. Front yard landscape is in good condition. Rear patio is covered. and has table and chairs, washer/dryer area with wash basin. LPA Iniguez and the Administrator toured the physical plant. There were no bodies of water or obstructions on the premises. LPA inspected a total of (7) bedrooms and (2) bathrooms. The beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. The bathrooms were found to be within Title 22 regulations and were operational. Smoke and carbon monoxide detectors were in operable condition. The water temperature ranged from 112°F to 116°F, and the room temperature ranged from 76°F to 78°F. The evaluation Report continues on the next page, LIC 809-C, providing further details of the inspection findings. During the visit, LPA Iniguez observed that the facility was clean, sanitary, and appropriately furnished. Storage areas for personal hygiene were in place. Cleaning supplies, toxins, and sharp objects were stored in a way that made them inaccessible to residents in care. The kitchen was inspected, and there was sufficient perishable and non-perishable food available, which was adequately maintained. All fire extinguishers were charged and operable. The last Fire/Disaster Drills were conducted on 3/25/24. A review of (3) residents' service files and (2) staff personnel files was maintained in order. LPA reviewed (3) Medication Administration Records (MARs) and found no discrepancies. LPA observed the facility's infection control practices. All mandated inspection control posters were displayed throughout the facility. A copy of liability insurance was given to LPA. Facility Annual Fess current. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies; therefore, no citations were issued at this time. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Gregg McEllven/ Administrator.the state’s words, verbatim · CDSS document, Jun 14, 2024