374603755-12-28-2022-08-AS-LTEZ-CMKUM8-20221229144151

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603755
Report Date: 12/28/2022
Date Signed: 12/28/2022 08:35:20 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/09/2022 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20221209162630

FACILITY NAME:	FAHIMA CARE HOME 1		FACILITY NUMBER:	374603755
ADMINISTRATOR:	RAUSHON AHMED		FACILITY TYPE:	740
ADDRESS:	8554 CAPRICORN WAY		TELEPHONE:	(858) 800-7455
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92126
CAPACITY:	6	CENSUS: 5	DATE:	12/28/2022
		UNANNOUNCED	TIME BEGAN:	04:15 PM
MET WITH:	Staff, Petra Galindez		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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-Neglect resulting in resident sustaining unexplained injury while in care
-Staff unable to communicate with resident's authorized representative due to language barrier

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to conclude the investigation regarding the above mentioned allegations. LPA identified herself and discussed the allegations mentioned above with Staff, Petra Galindez.

During the investigation, LPA toured the facility, reviewed records, interviewed staff, residents, and outside sources. It was alleged, neglect resulting in a resident sustaining an unexplained injury while in care. Resident #1 (R1) sustained a black eye, while in care. It was reported R1 woke up on 12/04/22 with a black eye. R1 has major neurocognitive disorder and stated they woke up with the black eye and was unable to provide any details on the occurrence. Resident interviews revealed not being aware of any residents sustaining injuries. Outside source and staff interviews confirmed R1 was observed on 12/04/22 and did not have a black eye. On 12/05/22, R1 was observed with a black eye by staff and outside sources. Staff interviews revealed once R1 was observed with the black eye, ice packs were applied and R1 did not complain of pain. Administrator’s interview revealed being made aware of the black eye by staff and first aid was applied. It is unknown how R1 sustained the black eye. Outside source interviews revealed the staff are good to the residents and do not suspect neglect or abuse, in their opinion. Continued on an LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

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

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20221209162630

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: FAHIMA CARE HOME 1	FACILITY NUMBER: 374603755
	VISIT DATE: 12/28/2022

NARRATIVE

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It was also alleged the staff are unable to communicate with resident's authorized representative due to a language barrier. Facility staff speak English, but it is their second language. It was reported an authorized representative was unable to communicate with staff due to the language barrier. Outside source interviews revealed there were no attempts made to communicate with the administrator or the owner when there was a language barrier with staff. Additional outside source interviews revealed being at the facility regularly and are able to communicate well with staff and the residents needs are being met. Interview with hospice representative revealed the staff communicate well and are attentive to the resident’s needs. Resident interviews revealed they are able to communicate with staff and have their needs met. Administrator’s interview revealed the staff communicate well with the residents and authorized representatives and if there were any issues, they could to speak with him. Administrator stated it has not been brought to his attention there was a language barrier with staff.

Based on interviews conducted the investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegations. The allegations are deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Staff, Petra Galindez whose signature below confirms receipt of these rights.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

LIC9099 (FAS) - (06/04)

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