374604277-3-21-2024-08-AS-JLOT-D3QL5Y-20240326082751

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604277
Report Date: 03/21/2024
Date Signed: 03/21/2024 12:12:57 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,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/25/2020 and conducted by Evaluator Marisela Garcia-Centeno

COMPLAINT CONTROL NUMBER: 08-AS-20200925145400

FACILITY NAME:	SAFE HARBOR ELDER CARE		FACILITY NUMBER:	374604277
ADMINISTRATOR:	RATHI, GAURAV		FACILITY TYPE:	740
ADDRESS:	3301 LOMAS SERENAS DRIVE		TELEPHONE:	(619) 791-5495
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92029
CAPACITY:	6	CENSUS: 6	DATE:	03/21/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Administrator, Nikita Mundhada		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Licensee did not follow physician's orders
Licensee violated resident's personal rights
Licensee did not provide staff with the appropriate training
Licensee did not provide adequate supervision, resulting in residents sustaining multiple injuries
Licensee does not properly assess the resident's needs, resulting in lack of care
Licensee's food supply is not of good quality

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced complaint visit to deliver investigative findings. LPA met with Administrator, Nikita Mundhada.

The Department investigated the above-listed complaint allegations. The investigation consisted of observations, a review of relevant records, and interviews with residents, facility staff, and outside sources.

On September 25, 2020, Community Care Licensing (CCL) received a complaint alleging that the licensee did not follow physician’s medication orders. It was specifically alleged that staff were not administering medications as prescribed. In addition, it was alleged that staff were taking residents’ medications for their personal use. The dates and/or times when staff did not administer medication as prescribed were not identified during the investigation.
(Continue at LIC-9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

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-20200925145400

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: SAFE HARBOR ELDER CARE	FACILITY NUMBER: 374604277
	VISIT DATE: 03/21/2024

NARRATIVE

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(Continue from LIC9099)

During multiple interviews with residents, staff, and outside sources it was consistently indicated that the residents were administered their medications according to their physician’s orders. A detailed review of the medication administration records from August 1, 2020, to September 10, 2020, for the six (6) residents disclosed no discrepancies of missing doses. In addition, the Department was unable to obtain credible information from records review, interviews with staff, and outside sources of when staff acquired residents' medication for their personal use.

It was alleged that the licensee violated the resident’s personal rights. It was specifically alleged that there was one incident when a staff member yelled at a resident. The date/time of when this incident occurred was not obtained during the investigation. Multiple interviews with staff, residents, and outside sources consistently indicated that staff treated residents with respect, and none had observed, heard, or witnessed any staff member yelling or mistreating any of the residents. During interviews, facility management stated that no resident had expressed any concerns regarding staff mistreating any of the residents.

It was alleged that the licensee did not provide staff with the appropriate training. Details of the type of training or which staff did not receive appropriate training were not obtained during the investigation. During interviews, facility staff confirmed that they had all received the required training in personal rights, reporting requirements, and all other training as required per Title 22 regulations. A review of a sample of staff training records indicated no violations of Title 22 training requirements, all staff completed the required initial training and annual training.

It was also alleged that the licensee did not provide adequate supervision, resulting in residents sustaining multiple injuries. It was specifically alleged that there was insufficient staff to meet the needs of the residents. Multiple interviews with staff, residents, and outside sources revealed no staffing concerns. A detailed review of staff schedules from August 1, 2020, to September 1, 2020, indicated that at least three (3) staff were scheduled during the morning and afternoon shifts, and at least one (1) staff was scheduled during the overnight shift. In addition, during interviews with staff and outside sources, it was consistently indicated that they were not aware of any resident sustaining multiple injuries due to lack of supervision. A detailed review of facility records indicated no unreported incident reports regarding residents’ injuries.

(Continue at LIC9099C)

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

LIC9099 (FAS) - (06/04)

Page: 1 of 1

Control Number 08-AS-20200925145400

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: SAFE HARBOR ELDER CARE	FACILITY NUMBER: 374604277
	VISIT DATE: 03/21/2024

NARRATIVE

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(Continue from LIC9099C)

It was also alleged that the licensee did not properly assess the resident's needs, resulting in lack of care. Details of when or which resident was not properly assessed were not obtained during the investigation. A detailed review of residents’ service care plans and relevant resident records indicated that all residents' assessments were completed as required by Title 22 regulations, at the time of admission, annually, and/or when there was a change in medical condition. The Department was unable to obtain credible information from resident interviews or outside sources corroborating this allegation.

Lastly, it was alleged that the licensee's food supply was not of good quality. It was specifically alleged that staff were serving expired food to residents. The dates/times of when this occurred were not disclosed during the investigation. During interviews with residents, staff and outside sources indicated that the food was of good quality and met residents’ food service needs.

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

An exit interview was conducted with Administrator, Nikita Mundhada, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 03/22) was provided at the conclusion of the visit.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

LIC9099 (FAS) - (06/04)

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