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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604019
Report Date: 10/04/2024
Date Signed: 10/04/2024 03:26:50 PM


Document Has Been Signed on 10/04/2024 03:26 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
SAN DIEGO RO, 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: 6DATE:
10/04/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Administrator Gaurav RathiTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Case Management visit. The LPA introduced himself and disclosed the purpose of the visit to Administrator Rathi.

During today’s visit, the LPA assessed an immediate $500 civil penalty in an LIC 421IM form. This civil penalty was in response to a previously substantiated complaint allegation (Complaint # 08-AS-20191231162534).

On December 31st, 2019, it was reported to the Department staff left a resident in soiled clothing. The Department investigated and substantiated the allegation on June 18th, 2021. During the visit, the LPA also delivered and amended LIC 9099D page, noting the deficiency was amended from a Type B to a Type A Deficiency.

An exit interview was conducted with Rathi, to whom a copy of this report, LIC 421IM form, and the Licensee Appeal Rights (LIC 9058), were provided.

SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2024
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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