374604860-8-23-2024-08-AS-AROS-D8ES9W-20240823134125

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604860
Report Date: 08/23/2024
Date Signed: 08/23/2024 01:41:36 PM

Document Has Been Signed on 08/23/2024 01:41 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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

FACILITY NAME:	DEL CERRO ELDER CARE		FACILITY NUMBER:	374604860
ADMINISTRATOR:	RATHI, GAURAV		FACILITY TYPE:	740
ADDRESS:	6288 WENRICH DR		TELEPHONE:	(619) 791-5495
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92120
CAPACITY:	6	CENSUS: 0	DATE:	08/23/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Licensee Gaurav Rathi and Administrator Abhinav Singh		TIME COMPLETED:	01:40 PM

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Licensing Program Analyst (LPA) Amy Rodgers conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted by, identified herself to, and explained the purpose of the visit to Licensee Gaurav Rathi and Administrator Abhinav Singh.

The facility fire clearance was granted on 08/6/2024 and reflected that the facility was approved for 6 non-ambulatory residents aged 60 and above. One of which can be bedridden. The facility's fire clearance did not include endorsements for delayed-egress doors or secured perimeter. The submitted facility sketch was consistent with the current layout of the facility.

LPA Rodgers toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were well lit and free of obstruction and slip hazards. Resident bedrooms allowed for easy passage and contained the required furnishings. Toilets, sinks, and showers were in working order.

During today’s visit, LPA, accompanied by Licensee Gaurav Rathi and Administrator Abhinav Singh, checked Hot water temperature at taps accessible to residents were also compliant: Bathroom #1 sink was 110 F, Bathroom #2 sink was 110.0 F The facility’s ambient internal temperature was complaint at 75 degrees..

The facility has enough linens, hygiene supplies, cooking and dining supplies, and perishable and non-perishable food for future resident use. All kitchen appliances were in working order.

The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. The facility has locked areas for storage of sharp objects, medication, and confidential resident and staff records. (CONTINUED ON LIC 809-C, NEXT PAGE)

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: DEL CERRO ELDER CARE	FACILITY NUMBER: 374604860
	VISIT DATE: 08/23/2024

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(CONTINUED FROM LIC 809)

There is a pool at the facility, made inaccessible to residents.There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Per Licensee Gaurav Rathi and Administrator Abhinav Singh no firearms or ammunition are or will be stored at the facility.

Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. All fire extinguisher(s) were serviced within the last twelve months. A complete first aid kit was present. Required licensing postings were observed in visible areas of the facility.

The items reviewed were complaint with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. The applicant passed the pre-licensing inspection.

LPA also reviewed the Component III Training with Rathi and Singh on 08/23/24. They were advised that the facility’s application is pending management final review and approval.

An exit interview was conducted with Licensee Gaurav Rathi, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024

LIC809 (FAS) - (06/04)

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