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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604019
Report Date: 06/30/2021
Date Signed: 06/30/2021 04:29:26 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:POINT LOMA ELDER CAREFACILITY NUMBER:
374604019
ADMINISTRATOR:GAURAV RATHIFACILITY TYPE:
740
ADDRESS:3941 LIGGET DRIVETELEPHONE:
(619) 255-6448
CITY:SAN DIEGOSTATE: CAZIP CODE:
92106
CAPACITY:6CENSUS: 5DATE:
06/30/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:34 PM
MET WITH:Gaurav Rathi, AdministratorTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Daniel Pena conducted a virtual case management visit via FaceTime to deliver an amended report to Administrator Gaurav Rathi. LPA identified himself and stated the purpose of the video-call.

LPA informed the licensee of the reasons for the amended report. The licensee was provided with the updated report for their records.

An exit interview was conducted with Administrator Rathi via video-call. A copy of this report along with Licensee Rights (LIC9058 01/2016) was provided to Mr. Rathi via email. An electronic response confirms the documents were received.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 994-7269
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021
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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