Inspection Reports for The Oakmont of Pacific Beach

The inspection was an unannounced required annual inspection conducted to evaluate compliance with licensing requirements for the facility.

The facility was found to be sanitary and in good repair with no deficiencies cited. Resident rooms, equipment, and safety measures met regulatory standards, and all required documentation was complete.

An unannounced complaint investigation visit was conducted following a complaint received on 2025-05-20 alleging the licensee did not ensure a resident received needed toenail care.

The investigation found no preponderance of evidence to prove the alleged violation occurred. Resident records, staff interviews, and outside source interviews indicated that the resident was receiving appropriate grooming assistance and end-of-life care, including regular toenail filing.

The complaint alleged that the licensee did not ensure Resident 1 received needed toenail care. The allegation was found to be unsubstantiated after investigation.

The inspection was an unannounced complaint investigation visit triggered by allegations that staff did not ensure the facility was kept free of pests, specifically bed bugs, and that reporting requirements were not followed.

The investigation found that a bed bug infestation was confirmed and treated promptly by the facility with appropriate pest control measures and resident relocation. Reporting requirements were met with timely notification to the licensing agency and responsible parties. The allegations were ultimately deemed unsubstantiated or unfounded due to lack of evidence supporting the claims.

The complaint alleged staff did not ensure the facility was free of pests and did not follow reporting requirements. The investigation revealed the infestation was treated promptly and reported appropriately. The complaint was unsubstantiated for the pest allegation and unfounded for the reporting allegation.

The inspection was an unannounced complaint investigation visit conducted in response to allegations that the facility did not provide medical attention and that facility staff did not meet a client's needs or provide supervision resulting in injuries.

The investigation substantiated that the facility failed to initiate 911 services promptly after a resident suffered a fall with a head injury, posing an immediate health risk. However, allegations that staff did not meet the client's needs or provide supervision resulting in multiple falls were unsubstantiated based on interviews and record reviews.

The complaint investigation was substantiated regarding failure to provide timely medical attention after a resident's fall with head injury. The allegation that staff did not meet the client's needs or provide supervision resulting in injuries was unsubstantiated.

The visit was an unannounced Case Management - Incident inspection in response to the licensee’s self-reported death of Resident #1 on 08/14/2024.

No deficiencies were observed or cited during the visit. A brief facility tour and welfare check on remaining clients found no safety concerns.

An unannounced required annual inspection was conducted to evaluate the facility's compliance with licensing regulations.

The facility was found to be clean, sanitary, and in good repair with no deficiencies observed or cited. All required safety equipment, furnishings, and documentation were in place and compliant.

The visit was conducted as a Case Management - Incident investigation following a self-reported incident involving the death of Resident #1 on 04/07/2024.

No deficiencies were cited during the visit. The Licensing Program Analyst reviewed records and conducted staff interviews related to the incident.

The investigation was triggered by a self-reported incident of a resident's death. Resident #1 was found ill in bed with an opened bottle of body wash in their room and later passed away at the hospital. The resident had a diagnosis of Major Neurocognitive Disorder and was allowed access to personal grooming items without risk.

The visit was conducted in response to the licensee’s self-reported death of Resident #1, which was received by the licensing office on 2024-02-06. The visit was an unannounced Case Management - Incident inspection.

During the visit, a brief facility tour and welfare check on remaining residents were performed with no safety concerns found. Additional care records were collected and staff interviewed. No deficiencies were cited during the visit.

The visit was triggered by a self-reported death of a resident (Resident #1) on 2024-02-05. No deficiencies or safety concerns were identified during the investigation.

The visit was a follow-up Case Management - Incident inspection conducted in response to the licensee’s self-reported death of Resident #1, originally reported on 10/05/2023, with the initial visit on 10/06/2023.

During the visit, no safety concerns were found after a brief facility tour and welfare check of remaining residents. Additional care records were collected and staff interviewed. No deficiencies were cited during this visit.

The visit was a case management investigation to review the circumstances surrounding a Death Report received on January 16, 2024.

No deficiencies were issued during the visit after reviewing facility records, conducting interviews, and requesting the Death Certificate.

Investigation was triggered by a Death Report received on January 16, 2024. No deficiencies were found.

The visit was conducted in response to the licensee’s self-reported death of Client #1, which occurred on 2023-09-25.

The Licensing Program Analyst conducted an unannounced case management incident visit, performed a brief facility tour and welfare check on remaining clients with no safety concerns found, reviewed pertinent records, and interviewed staff. No deficiencies were cited during the visit.

The visit was triggered by a self-reported death of a client (Client #1) on 2023-09-25. No deficiencies or safety concerns were found during the investigation.

The visit was initiated due to a self-reported incident (SOC341) involving a resident and an unidentified individual, requiring further investigation.

During the unannounced case management visit, no immediate health or safety concerns were observed, and no deficiencies were cited. The incident requires further investigation and possible additional follow-up visits.

The visit was triggered by a self-reported incident (SOC341) involving Resident 1 and an unidentified individual. The incident required further investigation.

An unannounced Case Management visit was conducted following an incident self-reported by the licensee involving a resident (R1) who eloped from the secured memory care unit on 08/01/2023.

The investigation found that the facility staff did not provide needed observation to Resident #1, which was material to the elopement incident. Door alarms functioned as designed but staff failed to timely respond to alarms, and staff shift changes contributed to lapses in supervision.

The visit was triggered by a complaint/self-report of a resident elopement incident on 08/01/2023. The complaint was substantiated based on evidence that staff failed to provide adequate observation and timely response to door alarms.

The visit was conducted in response to an LIC624 Incident Report regarding a resident who eloped from the facility without staff supervision on 08/01/2023.

During the visit, the Licensing Program Analyst verified the resident was unharmed, tested the facility's delayed-egress exit doors which were found operational and compliant, reviewed care and administrative records, and interviewed relevant staff. No deficiencies were observed or cited during the visit.

The visit was triggered by a complaint incident report of a resident eloping from the facility. The incident requires further investigation with possible follow-up calls or visits. No substantiation status was stated.

The inspection visit was conducted in response to a self-submitted LIC624 Incident Report regarding a medication error where a resident ingested a topical cream instead of having it applied as prescribed.

The investigation found that staff did not assist one resident with self-administered medication as prescribed, resulting in the resident ingesting a topical cream and experiencing temporary abdominal pain. The resident was evaluated at a hospital but not admitted overnight and had no lasting injury. The facility disciplined involved staff and retrained the medication technician team.

The visit was complaint-related, triggered by a medication error incident reported by the licensee. The complaint was substantiated as staff failed to administer medication correctly, causing temporary harm to the resident.

The inspection was conducted as an unannounced complaint investigation following allegations received on 01/06/2023 regarding untreated insect infestation and staff yelling at a resident.

The investigation found no evidence to support the allegations of untreated insect infestation or staff yelling at the resident. Facility inspections and pest control records showed no signs of infestation, and staff interviews and records indicated no incidents of yelling. Both allegations were deemed unsubstantiated due to lack of evidence.

The complaint alleged that the facility did not treat insect infestation and that staff yelled at a resident. The investigation included a facility tour, interviews, and records review. The allegations were found unsubstantiated due to insufficient evidence.

The visit was an unannounced Case Management visit conducted in response to a self-reported AWOL incident involving a resident on September 13, 2022.

No immediate health or safety issues were identified during the visit, and no deficiencies were cited or observed.

Licensing Program Analyst Daniel Pena conducted an annual required licensing inspection focusing on infection control at the facility.

The inspection verified compliance with infection control practices including symptom screening, use of PPE, and availability of cleaning supplies. No deficiencies were cited during the visit.

Unannounced case management visit to follow up on an incident report regarding a resident sent to the hospital.

No deficiencies were cited or observed during the visit. The Licensing Program Analyst toured the facility, interviewed staff and residents, and reviewed facility records.

The visit was conducted as a case management and other type visit to provide technical assistance and evaluate the facility's infection control mitigation plan including disinfection, testing, vaccination, screening protocols, and PPE use.

During the visit, no deficiencies were cited. The team interviewed the Executive Director and conducted a walkthrough of the facility, concluding with a debriefing and exit interview.

An unannounced case management visit was conducted to perform a health and safety check and review COVID-19 mitigation strategies via a virtual FaceTime visit.

The Licensing Program Analyst toured the facility and interviewed the Executive Director. No deficiencies were issued during this visit.

The inspection was an unannounced required 1-year visit to evaluate the facility's compliance with licensing regulations, including review of the COVID-19 Mitigation Plan.

No deficiencies were cited or observed during the visit. The facility was found to be in compliance with infection control measures and other regulatory requirements.