374604019-3-23-2023-08-AS-LTEZ-CQEVZM-20230330165257

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604019
Report Date: 03/23/2023
Date Signed: 03/23/2023 01:51:57 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/09/2022 and conducted by Evaluator Rebecca A Ruiz

COMPLAINT CONTROL NUMBER: 08-AS-20220309105309

FACILITY NAME:	POINT LOMA ELDER CARE		FACILITY NUMBER:	374604019
ADMINISTRATOR:	GAURAV RATHI		FACILITY TYPE:	740
ADDRESS:	3941 LIGGET DRIVE		TELEPHONE:	(619) 255-6448
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92106
CAPACITY:	6	CENSUS: 6	DATE:	03/23/2023
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Administrator Travonna Washington		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Meals did not meet resident's needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint investigation visit to deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Administrator Travonna Washington.

The Department’s investigation consisted of interviews with residents, staff, and outside sources, records review, and a tour of the facility. It was alleged that meals did not meet resident’s needs. Review of resident 1’s (R1) medical records revealed that R1 required a mechanical soft diet and required staff assistance with all activities of daily living, including eating meals, bathing, dressing, and toileting. Record review revealed that R1’s medical condition declined and R1 was admitted to hospice care in January 2022. Interviews and record review revealed that R1 had declined in meal intake directly prior to being admitted to hospice care and had poor meal intake while under hospice care.

Continued on LIC9099-C page...

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20220309105309

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 CARE	FACILITY NUMBER: 374604019
	VISIT DATE: 03/23/2023

NARRATIVE

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Interviews and records review did not support any evidence of R1 being denied food or water. Records review and interviews revealed that R1 passed away while under hospice care in February 2022 and the Department was unable to interview R1.

The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated.

An exit interview was conducted with Administrator Travonna Washington, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 01/16) were provided via hard copy.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

LIC9099 (FAS) - (06/04)

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