374603755-7-28-2023-08-AS-LTEZ-CUA4CC-20230731185855

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603755
Report Date: 07/28/2023
Date Signed: 07/28/2023 01:53:53 PM

Substantiated

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
07/13/2023 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20230713155200

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: 6	DATE:	07/28/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Staff, Petra Galindez		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Staff yelled at resident in care

INVESTIGATION FINDINGS:

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Licensing program Analyst (LPA), Natasha Persaud conducted an unannounced visit to conclude the investigation regarding the above mentioned allegation. LPA met with Staff, Petra Galindez.

During the investigation, the facility was toured, records requested, and interviews conducted with staff, residents, and outside sources. It was reported that Staff #1 (S1) yelled at Resident #1 (R1) in care. Evidence revealed on 07/13/23 R1 walked into the kitchen asking for a food item, stating they were hungry. S1 yelled at R1 to go to their bed. R1 has a Major Neurocognitive Disorder and wanders around the facility asking for food. Staff interviews revealed R1 will eat a meal and within minutes ask to eat again, as R1 forgot they ate, due to their medical condition. The resident interviews confirmed staff yelled at R1 to go to their bed. The administrator explained an outside source was at the facility and witnessed S1 yell at R1. Outside source interviews confirmed staff yelled at R1. Continued on an LIC 9099C.

Substantiated

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: 07/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023

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 5

Control Number 08-AS-20230713155200

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: 07/28/2023

NARRATIVE

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The administrator confirmed R1 has a Major Neurocognitive Disorder and explained R1 would constantly interrupt staff while they are busy providing care. Therefore, staff may end up raising their voice out of frustration. However, the staff are good caregivers and treat the residents with dignity. The administrator denied witnessing S1 yell at R1 to go to bed.

Based on interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California code of Regulations, Title 22, Division 6 & Chapter 8, is being cited on the attached LIC 9099D. 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: 07/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 08-AS-20230713155200

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/28/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/25/2023 Section Cited CCR 87468.1(a)(1)	1 2 3 4 5 6 7	Personal Rights of Residents in All Facilities. Residents in all Residential care facilities for the elderly shall have all of the following personal rights: To be Accorded dignity in their personal relationships with staff, residents, and other persons.	1 2 3 4 5 6 7	Administrator stated he will conduct In-Service training on Personal Rights to include communication.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on interviews, the licensee did not protect the personal rights for 1 out of 6 residents in care [R1] which posed a personal rights risk.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 5

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
07/13/2023 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20230713155200

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: 6	DATE:	07/28/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Staff, Petra Galindez		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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5
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9

Staff did not address resident's needs

INVESTIGATION FINDINGS:

1
2
3
4
5
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10
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13

Licensing program Analyst (LPA), Natasha Persaud conducted an unannounced visit to conclude the investigation regarding the above mentioned allegation. LPA met with Staff, Petra Galindez.

During the investigation, the facility was toured, records requested, and interviews conducted with staff, residents, and outside sources. It was reported that Staff #1 (S1) did not address Resident #1 (R1) needs. Evidence revealed on 07/13/23 R1 wandered into the kitchen asking for a food item, stating they were hungry. R1 has a Major Neurocognitive Disorder and wanders around the facility asking for food. Staff interviews revealed R1 will eat a meal and within minutes ask to eat again, as R1 forgot they ate, due to their medical condition. Staff also confirmed the facility has snacks and residents may eat whenever they are hungry. Staff interviews revealed R1 was always coming to the kitchen asking for food. R1 would eat, then within three (3) minutes, R1 would return asking for food as though they didn’t just eat. Staff stated they were aware R1 was asking for more food due to their medical condition not because R1 was hungry. 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: 07/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023

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

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 08-AS-20230713155200

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: 07/28/2023

NARRATIVE

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Staff also stated R1 doesn’t usually finish their meal. Therefore, they know R1 wasn’t hungry within three (3) minutes. Resident interviews confirmed R1 is provided meals and snacks daily. Resident interviews also revealed they can ask for more food or snacks at any time.

During the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation was 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: 07/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 5