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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 371881424
Report Date: 12/12/2024
Date Signed: 12/12/2024 01:43:31 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/28/2024 and conducted by Evaluator Kathleen Banrasavong
COMPLAINT CONTROL NUMBER: 18-AS-20240828150819
FACILITY NAME:ESCONDIDO ELDER CAREFACILITY NUMBER:
371881424
ADMINISTRATOR:RATHI, GAURAVFACILITY TYPE:
740
ADDRESS:135 S TULIP STTELEPHONE:
(619) 791-5495
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:6CENSUS: 6DATE:
12/12/2024
UNANNOUNCEDTIME BEGAN:
12:25 AM
MET WITH:Administrator, Nikita MundhadaTIME COMPLETED:
02:05 PM
ALLEGATION(S):
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Staff does not provide an adequate amount of food to resident
Staff do not provide resident with water when requested
Staff are taking away residents personal items
INVESTIGATION FINDINGS:
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Licensing Program Analyst, (LPA) Kathleen Banrasavong, conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegations. LPA met with Administrator, Nikita Mundhada, where LPA explained the purpose of the visit and the elements of the allegations. The investigation consisted of observations, interviews with staff members and residents, and a review of records.
On August 28th, 2024, Community Care Licensing received a complaint alleging staff does not provide an adequate amount of food to residents. It was reported that staff provided little breakfast in the morning. Information obtained from Administrator indicated that the facility provides three meals a day to residents and residents are able to receive additional servings. LPA interviewed Resident 1 (R1), who indicated that they are provided three meals a day; no concerns. LPA also interviewed staff members, who indicated that they prepare three meals for the residents and if a resident wants more servings, they are able to ask for it. Information obtained from additional resident interviews stated that they receive 3 meals a day and can ask for more servings if they wanted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
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 3
Control Number 18-AS-20240828150819
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ESCONDIDO ELDER CARE
FACILITY NUMBER: 371881424
VISIT DATE: 12/12/2024
NARRATIVE
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LPA toured the facility and ensured that there was adequate food supply that met the regulation standards. LPA reviewed the facility’s food menu and food offered at the facility corresponded to the menu listed.

Regarding the allegation that staff does not provide a resident with water when requested, it was alleged that the facility was not giving the resident water when requested. Administrator indicated that there is always water available at the facility. It was advised when R1 would ask for water, staff would give it to R1, but would complain to other staff that they weren’t given any. Administrator further stated that R1 would drink a cup of water and then advise additional witnesses that they were thirsty. LPA interviewed R1 who indicated that he was able to ask for water when he wanted it and provided in a timely manner. Interviews with other pertinent parties indicated that there were no issues with being provided water. LPA observed an adequate water supply at the facility.

It was also alleged that the facility is taking away the resident's personal items. It was reported that staff members would take R1’s cell phone and not return it. R1 stated that R1’s cell phone would be taken away to charge the device and R1 would have to ask the staff members to help R1 locate it. LPA interviewed Administrator and stated that the caregivers take the phone at night, to charge it, at the request of R1’s responsible party. It was advised that staff provides the cell phone to R1 once the phone is fully charged. In the LPA’s record review, LPA observed email correspondence that relayed this message from R1’s responsible party and PACE Social Worker. Information obtained from interviews with additional witnesses revealed no concerns regarding the facility taking away the resident’s personal items.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20240828150819
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ESCONDIDO ELDER CARE
FACILITY NUMBER: 371881424
VISIT DATE: 12/12/2024
NARRATIVE
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Based on the information obtained during the investigation, this agency has investigated the complaint that staff does not provide an adequate amount of food to residents, staff does not provide water when requested, and staff are taking away residents’ personal items. Although the allegations may have occurred or be valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated.

An exit interview was conducted, and a copy of this report was discussed with and provided to Administrator Nikita Mundhada.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3