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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 03:16:14 PM


Document Has Been Signed on 10/04/2024 03:16 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:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Lincensee Gaurav Rathi and Administrator Travonna Washington TIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Required Annual Inspection. The LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Hugo Perez. Licensee Gaurav Rathi and Administrator Travonna Washington arrived during the visit and assisted the LPA. The facility was licensed for a capacity of six (6) non-ambulatory residents, of which one (1) could be bedridden in room #4. The facility was also approved for hospice waiver for three (3) residents.

The LPA, accompanied by staff, toured the interior and exterior of the facility, and inspected each room. The facility
was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms
contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens
and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and
equipment to facilitate dining, laundry, visitation, meetings, and client activities.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored.
Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to clients.
Medications were labeled, and stored in a locked area.

No pools or bodies of water on the premises. Per staff, no firearms or ammunition are kept at the facility. Carbon
monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. Required licensing postings were observed in visible areas of the facility.

LPA interviewed staff and reviewed multiple staff and client records/files. The files which LPA reviewed contained
required documents. No deficiencies were cited during today's annual inspection.
.
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 374604019
VISIT DATE: 10/04/2024
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The LPA provided technical advise, and advised the Licensee to maintain a copy of the Plan of Operation at the facility, store medication in their original container, and maintain a copy of the active administrator certificate at the facility.

An exit interview was conducted with licensee Rathi, to whom a copy of this report, and Licensee 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
LIC809 (FAS) - (06/04)
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