371881424-9-8-2023-18-AS-JROO-CVGRM7-20230908130817

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 371881424
Report Date: 09/08/2023
Date Signed: 09/08/2023 01:08:21 PM

Document Has Been Signed on 09/08/2023 01:08 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	ESCONDIDO ELDER CARE		FACILITY NUMBER:	371881424
ADMINISTRATOR:	RATHI, GAURAV		FACILITY TYPE:	740
ADDRESS:	135 S TULIP ST		TELEPHONE:	(619) 791-5495
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92025
CAPACITY:	6	CENSUS: 0	DATE:	09/08/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Applicant Gaurav Rathi		TIME COMPLETED:	01:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 9/8/2023, Licensing Program Analyst (LPA) Janette Romero conducted an announced visit to the pending facility to conduct a pre-licensing inspection. LPA met with Applicant Guarav Rathi. Fire clearance has been granted for six (6) non-ambulatory elderly residents, of which one (1) may be bedridden. Applicant Rathi's Administrator certificate expires on 10/3/2024. LPA conducted of a tour of the facility’s interior and exterior. The facility is made up of a one-story home with six (6) resident bedrooms, three (3) resident bathrooms, a kitchen, living/family room, supply room and laundry room. LPA did not observe bodies of water on the premises. The physical plant is in good repair. Indoor and outdoor passageways are free of obstruction. An outdoor shaded seating area is available for future residents. LPA observed two (2) charged fire extinguishers mounted in the dining room wall and hallway. LPA tested the smoke alarms and carbon monoxide detectors and found them to be operational. The facility also has a working telephone. LPA observed a locked cabinet for resident and staff files and centrally stored medications. Cleaning solutions and knives/sharp instruments will be secured in kitchen cabinets. Resident bedrooms had the required bedding, furniture, closet storage, and functional lighting. Additional linen and towels are available for future residents. LPA toured the kitchen and observed that food was stored in a safe and healthful manner. The facility had a 2-day supply of perishable food items and 7-day supply of nonperishable food items. LPA observed emergency food and water in the laundry room. Continued on LIC809-C..

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Janette Romero	TELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ESCONDIDO ELDER CARE	FACILITY NUMBER: 371881424
	VISIT DATE: 09/08/2023

NARRATIVE

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Continued from LIC809..

Bathrooms were equipped with a grab bar near the toilet and in the shower. The hot water temperature in the resident bathrooms measured to 108-degrees Fahrenheit. Living/family room has a working television and adequate seating in common areas. The facility has a centralized heating and air conditioning system installed and the central panel is in the hallway to control some resident bedrooms and all common areas. Two resident bedrooms have portable air conditioning units, in which residents will be able to control their room temperature. Emergency disaster plans, personal rights, and complaint procedures were posted in living/family room wall. LPA observed a complete first aid kit.

During today’s visit, LPA did not observe any issues or concerns.

Applicant Rathi is scheduled to complete the Comp III on Tuesday, 9/12/2023, at 9:00 a.m., at the Riverside Regional Office. Final approval of licensure will be granted by the Centralized Application Bureau analyst.

An exit interview was conducted where a copy of this report was discussed and provided to Applicant Rathi.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Janette Romero	TELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023

LIC809 (FAS) - (06/04)

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