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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604019
Report Date: 10/31/2022
Date Signed: 10/31/2022 11:53:15 AM


Document Has Been Signed on 10/31/2022 11:53 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
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: 6DATE:
10/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Gary Rathi, AdministratorTIME COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) Tiffany Holmes, conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPA met with Gary Rathi, Administrator, and discussed the purpose of the visit. All staff present have a current criminal record clearance.

LPA conducted a tour of the facility, both inside and outside and observed the residents in care. In accordance with the Department’s Infection Control, LPA Holmes provided technical assistance, evaluated, and observed the facility's implementation of their mitigation plan to include disinfection, testing surveillance, and screening protocols as well as the use of personal protective equipment.

No deficiencies were cited or observed on this date.

Rathi was provided a copy of their appeal rights (LIC9058 03/22). An exit interview was conducted and a copy of this report was given to Gary Rathi, Administrator.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Tiffany HolmesTELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:
DATE: 10/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/31/2022
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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