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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604019
Report Date: 10/04/2024
Date Signed: 10/25/2024 10:09:35 AM

Document Has Been Signed on 10/25/2024 10:09 AM - 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/
DIRECTOR:		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 VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Licensee Gaurav RathiTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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This is an amended report of a report originally signed on 10/04/2024.

Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Case Management visit. The LPA introduced himself and disclosed the purpose of the visit to Licensee 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-20190809110049).

On August 9th, 2019, it was reported to the Department neglect resulted in a resident sustaining a stage 4 pressure injury. The Department investigated and substantiated the allegation on September 30th, 2020. At this time, pursuant to Health and Safety Code Section 1569.49, a civil penalty assessment is under review by the Program Administrator of the Community Care Licensing Division.

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.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
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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