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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604019
Report Date: 03/30/2023
Date Signed: 03/30/2023 11:31:36 AM


Document Has Been Signed on 03/30/2023 11:31 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:
03/30/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Travonna Washington, Facility ManagerTIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Carmen Lopez conducted a visit to the facility to deliver findings for an investigation and in conjunction conduct this case management visit. LPA identified herself and was granted entry by Carmelita Crisolo, Caregiver. LPA met with Travonna Washington, Facility Manager and disclosed the purpose of the visit. Niki Mundhada Rathi, Co-Administrator later arrived and joined the visit.

LPA reviewed Title 22, Division 6, Chapter 8, Section 87468.1 Personal Rights of Residents in all Facilities; and 87465 Incidental Medical and Dental Care. No deficiencies were cited during today’s visit.

An exit interview was conducted with Co-Administartor Rathi and technical advisories were given per Title 22, Division 6, Chapter 8 of the California Code of Regulations. A copy of this report along with the Licensee Appeal Rights (LIC9058 03/22) were provided to Co-Administartor Rathi at the conclusion of the visit. The signature below confirms the documents were received.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2023
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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