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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 371881424
Report Date: 02/03/2025
Date Signed: 02/03/2025 11:04:15 AM

Document Has Been Signed on 02/03/2025 11:04 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 CAREFACILITY NUMBER:
371881424
ADMINISTRATOR/
DIRECTOR:		RATHI, GAURAVFACILITY TYPE:
740
ADDRESS:135 S TULIP STTELEPHONE:
(619) 791-5495
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY: 6CENSUS: 6DATE:
02/03/2025
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Administrator, Nikita MundhadaTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Kathleen Banrasavong made an unannounced visit to conduct a case management visit in reference to the Non- Compliance Summary (LIC 9111) signed on 01/22/2025. LPA toured the facility and did not observe any immediate health and safety concerns. LPA conducted a health and safety check and met with Administrator, Nikita Mundhada and explained the purpose of today’s visit. At the time of the LPA’s visit, there were six (6) residents who live at the facility. There was two (2) staff members present at the time of the visit.

LPA conducted a tour of the inside and outside of the facility accompanied by the Administrator. The licensee is operating the facility within the conditions and limitations specified on the license, including the capacity limitation.



LPA toured the interior and exterior of the plant of the facility. In the kitchen there was supply of perishable and non-perishable food supply for the 6 residents, which met regulations standards. The facility does not safeguard five (5) out of 6 (six) resident’s monies due to each resident having a responsible party, who does so. The remaining one (1) resident handles their own finances. There are no residents that are bedridden. LPA did not observe any locks in the resident’s bedroom. LPA did not observe any restraint devices at the facility. Interviews with residents and staff indicted that there are no restraint devices used at the facility. There were no residents under hospice care at the facility.

The LPA did not observe any violations of CCR 87464 Basic Service, CCR 87609 Allowable Health Conditions and the Use of Home Health Agencies, CCR 87468.2 Additional Personal Rights of Residents in Privately Operated Facility, CCR 87625 Managed Incontinence, CCR 87411 Personnel Requirement, during the LPA’s visit.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2025
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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ESCONDIDO ELDER CARE
FACILITY NUMBER: 371881424
VISIT DATE: 02/03/2025
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During the LPA’s visit, LPA reviewed copies of pertinent documentation. LPA reviewed residents’ copies of the Needs and Services Plan, Medical Assessment, Medication Logs, Medication list, Admission agreement. There were no deficiencies were cited during this visit, as there were no health and safety concerns observed during today's visit. The LPA did not observe any violations of the Title 22, Division 6, Chapter 8 regulations.

An exit interview was conducted and a copy of this report, the LIC 811 were provided to the Administrator, Nikita Mundhada.

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

DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2025
LIC809 (FAS) - (06/04)
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