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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 371881424
Report Date: 12/12/2024
Date Signed: 12/12/2024 01:40:42 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/02/2024 and conducted by Evaluator Kathleen Banrasavong
COMPLAINT CONTROL NUMBER: 18-AS-20241202135528
FACILITY NAME:ESCONDIDO ELDER CAREFACILITY NUMBER:
371881424
ADMINISTRATOR:RATHI, GAURAVFACILITY TYPE:
740
ADDRESS:135 S TULIP STTELEPHONE:
(619) 791-5495
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:6CENSUS: 6DATE:
12/12/2024
UNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Administrator, Nikita MundhadaTIME COMPLETED:
02:05 PM
ALLEGATION(S):
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Facility staff do not treat residents with dignity and respect.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kathleen Banrasavong conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegation. LPA met with Administrator, Nikita Mundhada, where the LPA explained the purpose of the visit and the elements of the allegation. The investigation consisted of observations, interviews with staff members and residents, and a review of records.

On December 6th, 2024, Community Care Licensing received a complaint alleging that facility staff do not treat residents with dignity and respect. The complaint alleged that Resident 1 (R1) had their feelings hurt by staff. It was reported that R1 was upset with staff because staff was trying to limit his soda consumption due to R1’s health issues. Information obtained from interview with Administrator stated that the facility does not purchase soda for clients. It was stated that R1 personally purchases their drinks, which R1 has the right to. Administrator denied that staff members interfere with R1’s right to choose their choice of beverages.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
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 2
Control Number 18-AS-20241202135528
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ESCONDIDO ELDER CARE
FACILITY NUMBER: 371881424
VISIT DATE: 12/12/2024
NARRATIVE
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Information obtained from interview with R1 stated that staff has made comments about R1 wanting to keep their drinks in R1’s room. Information obtained from interviews with staff stated that they respect the resident’s personal choices.

It was also alleged that the facility is not respecting the resident’s personal space. On November 28, 2024, Resident 2 (R2) accidentally entered R1’s room and began to rub R1’s leg. It was advised that R2 believed the room was assigned to them. Administrator stated that all staff members have received personal rights and supervision training. Administrator stated the incident was an accident and occurred one time. Administrator indicated that the facility has sufficient staffing to care for the residents’ needs and supervision. Information obtained from interview with R1 indicated that they like to keep their room as their personal space and does not like unwelcomed guests entering, unless given permission. R1 stated that R2 entered their room with permission and it happened once. Information obtained from interview with staff members stated they try to provide all residents with privacy. It was advised that the incident where R2 entered R1’s room did occur. Interviews with additional witnesses revealed there were no issues regarding facility staff not treating residents with dignity and respect.

Based on the information obtained during the investigation, this agency has investigated the complaint that facility staff do not treat residents with dignity and respect. Although the allegation may have occurred or be valid, there is not a preponderance of evidence to prove that the alleged violation(s) did or did not occur. Therefore, the allegation is unsubstantiated.

An exit interview was conducted, and a copy of this report was discussed with and provided to Administrator, Nikita Mundhada.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2