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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604281
Report Date: 05/28/2026
Date Signed: 05/28/2026 03:13:01 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/21/2026 and conducted by Evaluator Janet Ngallo
COMPLAINT CONTROL NUMBER: 08-AS-20260521152203
FACILITY NAME:OAKMONT OF PACIFIC BEACHFACILITY NUMBER:
374604281
ADMINISTRATOR:AMIRHOUSEHMAND, SHAWNFACILITY TYPE:
740
ADDRESS:955 GRAND AVETELEPHONE:
(858) 373-9300
CITY:SAN DIEGOSTATE: CAZIP CODE:
92109
CAPACITY:92CENSUS: 65DATE:
05/28/2026
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Executive Director Shawn AmirhoushmandTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Resident sustained injuries due to staff neglect.
Facility did not ensure maintenance of resident’s personal care equipment.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Janet Ngallo conducted an unannounced visit to initiate a complaint investigation and deliver findings regarding the above mentioned allegations. LPA identified themselves and met with Executive Director Shawn Amirhoushmand to discuss the purpose of the visit and elements of the complaint.

On 05/21/2026, it was alleged that a resident(R1) sustained injuries due to staff neglect, and that the facility did not ensure maintenance of R1's personal care equipment. The department's investigation consisted of interviews, records review, and LPA observations.

[Cont. on LIC 9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 08-AS-20260521152203
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: OAKMONT OF PACIFIC BEACH
FACILITY NUMBER: 374604281
VISIT DATE: 05/28/2026
NARRATIVE
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[Cont. from LIC 9099]

Regarding the allegation that R1 sustained injuries due to staff neglect, an incident that occurred on 11/20/2024, where R1 attempted to pet a visiting dog at the facility, resulted in the dog injuring R1 and causing a laceration that required medical attention. Interviews consistently reported that staff at the time of the incident responded immediately to the incident, contacted emergency services, and ensured the resident received prompt medical care. Staff further stated that the dog involved in the incident belonged to a visitor and that the staff involved had no ability to predict or control the behavior of the visiting animal. Staff also reported that R1 remained ambulatory following the incident, was assisted with ADLs as needed, and received ongoing redirection, monitoring, and wellness checks consistent with R1’s care needs. Interviews regarding a more recent fall incident that occurred on 05/18/2026, reported that R1 attempted to get out of bed independently in order to use the bathroom, resulting in an unwitnessed fall. Staff reported that they routinely encourage R1 to use mobility supports such as a walker, remind R1 to move slowly, and provide escort assistance as needed, however R1 often will refuse to use assistive devices.

Records review of R1's incident report from 05/18/2026 revealed an unwitnessed fall that occurred as R1 attempted to get out of bed to use the bathroom. Emergency services were called, and R1 was transported for treatment and diagnosed with a hip fracture requiring surgery. Review of R1's service plan documented that R1 was able to independently transfer and ambulate within the facility with walker use, required staff observation due to fall risk, and to receive regular status checks and reminders to use assistive devices. Records also revealed that R1 had a history of refusing assistance and demonstrating impulsive behaviors related to advanced Alzheimer’s disease.

Regarding the allegation that the facility did not ensure maintenance of R1's personal care equipment, specifically related to R1's hospital bed provided by a hospice agency, staff reported that they observed no mechanical issues with R1's bed prior to its removal. Staff consistently stated that the bed functioned properly, had operational half-rails, and assisted R1 with getting in and out of bed. Interviews further indicated that R1’s recent fall occurred as R1 attempted to get up independently despite being a high fall risk, and not due to any equipment failure. Interviews additionally reported that R1's bed was taken due to being discharged from their hospice agency following the fall since R1 was admitted to the hospital.

[Cont. on LIC 9099-C pg.1]

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20260521152203
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: OAKMONT OF PACIFIC BEACH
FACILITY NUMBER: 374604281
VISIT DATE: 05/28/2026
NARRATIVE
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[Cont. from LIC 9099-C]

Records review confirmed that on 05/18/2026, R1 was discharged from hospice services, as documented in the hospice discharge summary dated 05/19/2026. During the visit, LPA observed R1’s room to be clean, well-kept, and free of safety hazards. The hospital bed was no longer present, and R1 was still hospitalized at the time of the investigation.

Interview attempts with R1's responsible party were unsuccessful during the time of the investigation.

Based on interviews, records review, and LPA observation, the preponderance of evidence standard has not been met, therefore the above allegations are found to be unsubstantiated. An exit interview was conducted with Executive Director Shawn Amirhoushmand and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), were provided. Their signature confirms receipts of these documents.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Janet Ngallo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3