Above average — CMS composite of the measures below.
A standard survey is most likely before around September 2026
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Ocean View Post Acute during CMS and state inspections, most recent first.
Failure to supervise a resident during bedside care led to a fall from bed. A CNA left a cognitively intact resident with hemiplegia/hemiparesis lying on her side in a raised bed while she went to find an RN for a lidocaine patch. The resident rolled off the bed, was found on the floor with the bed still at waist level, and was later diagnosed with a displaced femoral neck fracture requiring surgery.
Failure to permit a resident to return after an ED visit: A resident with aphasia and moderate cognitive impairment was sent to the hospital for headache evaluation, was medically cleared after a negative CT, and was then told the facility would not take him back. The resident was homeless, had no discharge order or discharge plan, and left without his belongings or medications, while staff cited prior altercations and a request for a private room as reasons for refusing readmission.
A LTC facility failed to notify a resident's representative about the availability of requested medical records. The Social Worker did not inform the representative that the records were ready for pickup, resulting in a delay of seven days before the records were delivered. The facility's policy required written notification of the cost and availability of records, which was not followed.
A resident with dementia and a fractured femur was left unsupervised during an outpatient appointment due to a failure in confirming escort arrangements. The transportation company returned without the resident, who was later found outside and sent to the hospital. The facility's policies did not adequately address escort procedures, and nursing staff failed to document transportation details.
A resident with dementia and a history of elopement was discharged to an independent living facility without proper documentation or a discharge care plan, leading to the resident's readmission to the hospital. The interdisciplinary team failed to document the decision-making process or assess the suitability of the discharge destination.
Failure to Supervise Resident During Bedside Care
Penalty
Summary
The facility failed to provide care and services to prevent accidents for one resident with left-sided hemiplegia, hemiparesis, generalized weakness, and a need for assistance with personal care. The resident’s MDS indicated she was cognitively intact, fully dependent on staff for mobility, and had no prior fall history. The facility’s fall prevention policy stated that residents at risk should receive individualized interventions, including low bed use and increased supervision as indicated by assessment. On 4/24/26, a CNA was assisting the resident with getting changed and dressed when the resident asked for a lidocaine patch before being fully dressed. The CNA left the resident in bed positioned on her left side and did not return her to a supine position or lower the bed before leaving the room to find the medication nurse. The CNA later stated the bed was left in a raised high position and that it was unsafe to leave the resident side lying without supervision. A few minutes after the CNA left, the resident fell from the bed. After the fall, staff found the resident on the floor in a sitting position facing the bed, with the bed still raised at waist level. The resident reported she had been lying on her left side near the edge of the bed and shifted her weight before falling. The resident was transported to the hospital and was found to have a displaced femoral neck fracture, requiring surgical intervention. The ADON and DOR both stated the fall was preventable and that the resident should have been placed on her back in the middle of the bed with the bed lowered or staff should have waited for assistance before leaving her unattended.
Failure to Permit Resident Return After ED Visit
Penalty
Summary
The facility failed to allow a resident to return after an ED visit, despite the resident being medically cleared and the facility having no discharge order in place. The resident had aphasia following a cerebral infarction and an MDS dated 3/28/26 showed a BIMS score of 12, indicating moderate cognitive impairment. An interdisciplinary care conference dated 3/31/26 noted the resident was homeless and did not have a discharge plan. On 4/14/26, the resident was transferred to the hospital for evaluation of unresolved headaches, and the facility administrator stated a CT scan was negative and the resident was not admitted. The administrator further stated the resident was not permitted to return because he was independent with ADLs, had altercations with other residents, and behaviors, and that the admissions director was instructed not to accept him back. The resident stated that after the CT scan, the hospital case manager told him the facility would not allow him to return, and he was left waiting for transportation before using a ride share service to go to a friend's office space. He reported that his belongings remained at the facility and that he did not have his medications, including Plavix. The ED case management note documented communication with the facility liaison about the resident's return, with the liaison stating the resident had hit one of his roommates and was demanding a private room that was not available. The social services director stated the resident was homeless and did not yet have a discharge plan, while the PCP stated the resident was medically cleared to return and had no discharge orders from the facility. The facility policy stated discharge planning should focus on the resident's goals and transition to post-discharge care, and staff interviews acknowledged the need for a physician order, discharge education, and coordination of services for a safe discharge.
Failure to Notify Resident's Representative of Medical Records Availability
Penalty
Summary
The facility failed to respond appropriately to a medical records request for a resident diagnosed with dementia. The resident's responsible party emailed a request for medical records to the Social Worker (SW) on February 17, 2025. The SW planned to have the records ready by February 21, 2025, as requested. However, the SW did not notify the responsible party that the records were ready for pickup on the specified date. Instead, the SW received another request on February 24, 2025, and delivered the records on that day, seven days after the initial request. The Director of Nursing (DON) confirmed that the facility's procedure required notifying the requester when the records would be ready. The facility's policy stated that the requesting party should be notified in writing about the cost and availability of records two days after payment receipt.
Resident Left Unsupervised During Appointment
Penalty
Summary
The facility failed to prevent a hazardous situation when a resident was left unsupervised during an outpatient appointment, resulting in the resident's whereabouts being unknown. The resident, who had a diagnosis of a fractured right femur and unspecified dementia, was scheduled for a follow-up appointment with an orthopedist. The social services department was responsible for arranging transportation and escorts for such appointments. However, the social services assistant assumed that the resident's responsible party would accompany the resident but did not confirm this arrangement. On the day of the appointment, the transportation company picked up the resident but returned without him, as he could not be located at the orthopedist's office. The transportation document indicated that the resident required a companion, but the section specifying where the responsible party would meet the resident was left blank. The resident was later found outside the building by a bystander and was sent to the hospital. The facility's staff, including the social services director and assistant, acknowledged that failing to confirm the escort arrangement increased the risk of the resident being placed in an unsafe situation. The facility's policies on transportation and accidents did not adequately address the procedures for providing escorts to outside appointments. The nursing staff did not document the transportation details in the resident's progress notes, which was expected practice. The director of nursing and the administrator admitted that the facility did not confirm or document who was attending the appointment with the resident, leading to the resident being left unsupervised and at risk of harm.
Failure to Appropriately Discharge Resident with Elopement Risk
Penalty
Summary
The facility failed to appropriately discharge a resident with an elopement risk, leading to the resident's readmission to the hospital. The resident, who had a history of dementia and repeated falls, was admitted to the facility after being found wandering and placed on a 5150 hold. Despite these risks, the resident was discharged to an independent living facility without proper documentation or an appropriate discharge care plan. The interdisciplinary team did not document the decision-making process or assess the suitability of the independent living facility for the resident's needs. Interviews with the facility administrator, assistant director of nurses, and social service director revealed that there was no documentation regarding the resident's elopement risk or the appropriateness of the discharge destination. Additionally, there was no discharge care plan developed for the resident. The facility's policy and procedure for discharge planning required an active discharge care plan involving the interdisciplinary team, but this was not followed. As a result, the resident was readmitted to the hospital, highlighting the facility's failure to ensure a safe and appropriate discharge process.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Escondido
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Redwood Terrace Health Center | 0.6 mi | ★★★★★ | 0 | 0 |
| Valley Vista Post Acute | 1.2 mi | ★★★★★ | 24 | 0 |
| Palomar Vista Healthcare Center | 2 mi | ★★★★★ | 32 | 0 |
| Escondido Post Acute | 2.3 mi | ★★★★★ | 2 | 0 |
| Palomar Heights Post Acute | 2.4 mi | ★★★★★ | 5 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.