374603755-4-22-2022-08-AS-LTEZ-CEZ2FC-20220601172118

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603755
Report Date: 04/21/2022
Date Signed: 04/22/2022 07:59:12 AM

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
04/13/2022 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20220413101245

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: 4	DATE:	04/21/2022
		UNANNOUNCED	TIME BEGAN:	02:35 PM
MET WITH:	Administrator, Raushon Ahmed.		TIME COMPLETED:	04:02 PM

ALLEGATION(S):

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-Staff did not treat resident with dignity
-Licensee did not safeguard resident's belongings

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to commence a complaint investigation. LPA identified herself and discussed the allegations mentioned above with Administrator, Raushon Ahmed.

During today's visit, LPA briefly toured the facility and interviewed staff and residents. It was alleged Staff #1(S1) did not treat Resident #1 (R1) with dignity. It was reported S1 yelled at R1 regarding R1's catheter bag regularly leaking on the floor of the facility. Administrator's interview revealed being present when R1's catheter bag leaks and S1 will respond quickly by alerting R1 of the leaking urine. Administrator explained there is no yelling, it is a quick response and/or reaction by staff that notice the urine bag leaking on the floor, they alert R1. Staff interviews revealed R1 will carry the full urine bag to the bathroom to empty, but spills the urine down the hallway and staff are constantly cleaning up the urine to ensure there is no slipping hazard. Investigation revealed S1 has a loud voice, which can be interpreted as yelling. S1's interview revealed denial of yelling at R1. However, S1 explained they will react quickly by alerting R1 the urine bag is leaking. Resident interviews revealed S1 has a loud and stern voice, which can be misinterpreted as yelling. 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: 04/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

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-20220413101245

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: 04/21/2022

NARRATIVE

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It was also alleged, the licensee did not safeguard R1's personal belongings. It was reported S1 stole some jewelry items from R1. Investigation revealed there were no specific dates of when the items were stolen. In addition, the missing jewelry was a light up plastic necklace and an unidentified necklace. Staff interviews revealed denial of taking R1's personal belongings. Administrator's interview revealed R1 has a history of losing items and taking items out of the facility and not brining them back. Further interviews revealed there are no other residents missing items.

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. Therefore, the allegations are deemed unsubstantiated.

An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) was provided to Staff, Raushon Ahmed whose signature below confirms receipt of these rights. [See LIC 811 Confidential Name List to identify Resident #1 and Staff #1]

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

LIC9099 (FAS) - (06/04)

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