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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604485
Report Date: 08/20/2026
Date Signed: 08/21/2026 08:15:22 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
06/17/2026 and conducted by Evaluator Angelica Boyles
COMPLAINT CONTROL NUMBER: 08-AS-20260617081453
FACILITY NAME:POWAY ELDER CAREFACILITY NUMBER:
374604485
ADMINISTRATOR:RATHI, GAURAVFACILITY TYPE:
740
ADDRESS:14846 ESPOLA RDTELEPHONE:
(419) 377-9822
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:6CENSUS: 6DATE:
08/20/2026
UNANNOUNCEDTIME BEGAN:
08:38 AM
MET WITH:Alexa Cardenas - House ManagerTIME COMPLETED:
12:31 PM
ALLEGATION(S):
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Staff did not seek medical attention for residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced visit to the facility to deliver investigative findings regarding the above mentioned allegation. LPA identified herself, explained the purpose of the visit and nature of the complaint to House Manager Alexa Cardenas.

On June 17, 2026 the Department received this complaint which alleged staff did not seek medical attention for residents. The Department’s investigation included a facility tour, record reviews, as well as interviews with staff and residents.

(Continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Angelica Boyles
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 08-AS-20260617081453
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: POWAY ELDER CARE
FACILITY NUMBER: 374604485
VISIT DATE: 08/20/2026
NARRATIVE
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(Continued from LIC9099)

An incident report submitted by the facility to the Department on 6/15/26 revealed that on 6/14/26 a fire broke out in the caregiver rest area which was put out by staff using water and a fire extinguisher. Per interviews with staff, none of the residents were in areas impacted by the fire and were removed from the immediate health and safety risk of the fire and smoke. Facility staff called 911 and the fire department came. The Reporting Party alleges that after this event staff did not seek medical attention for residents. Staff reported not observing any of the residents to be in medical duress from the incident. Additionally, when the fire department arrived they did not assess any residents to need medical attention.

The Department has investigated the allegation that staff did not seek medical attention for residents. Based upon the information obtained during this investigation, it is determined that the preponderance of evidence was not met to support or corroborate this allegation and therefore deemed unsubstantiated.

An exit interview was conducted with House Manager Alexa Cardenas, to whom a copy of this report and the Licensee’s Rights (LIC9058 01/16) were provided at the conclusion of the visit.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Angelica Boyles
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2