374603755-10-20-2021-08-AS-IESA-C8A82E-20211029220750

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603755
Report Date: 10/19/2021
Date Signed: 10/20/2021 09:39:39 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
10/13/2021 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20211013094608

FACILITY NAME:	FAHIMA CARE HOME 1		FACILITY NUMBER:	374603755
ADMINISTRATOR:	RAUSHON AHMED		FACILITY TYPE:	740
ADDRESS:	8554 CAPRICORN WAY		TELEPHONE:	(858) 800-7455
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92126
CAPACITY:	6	CENSUS: 3	DATE:	10/19/2021
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Administrator, Raushon Ahmed		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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-Staff threatened resident
-Staff did not safeguard resident's personal property

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to commence a complaint investigation. LPA identified herself and discussed the allegations mentioned above with Administrator, Raushon Ahmed.

During today's visit, LPA briefly toured the facility, and interviewed staff and residents. It was alleged Staff #1(S1), threatened to throw away Resident #1's (R1) clothing. S1 denied threatening to throw R1's clothing away. Interviews revealed there were no witnesses that observed hearing S1 threaten R1 or observe S1 throw R1's clothing away. Additional staff interviews revealed S1 would never throw away a resident's clothing or personal property. R1 currently has all of their clothing in their possession.

It was also alleged staff is not safeguarding R1's personal property. It was reported S1 is throwing away R1's magazines and jewels. S1 denied throwing away R1's personal property. It was reported R1 went into the trash and found their synthetic Australian crystal and magazine thrown away. Continued on an LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021

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-20211013094608

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: FAHIMA CARE HOME 1	FACILITY NUMBER: 374603755
	VISIT DATE: 10/19/2021

NARRATIVE

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R1 was unable to show LPA the crystal or magazine that was taken out of the trash. Interviews revealed R1 has multiple items in their room and unable to locate specific items. S1's interview revealed R1's room is cleaned daily, items are moved to allow for cleaning but they are not removed from R1's bedroom. Further interviews revealed R1 is aware S1 is required to clean their room daily to ensure disposal of soiled briefs and overall cleaning. LPA observed R1's bedroom, there were multiple items in the room, to include items in multiple boxes and items on the floor. It was discovered, R1 requires some assistance to organize their bedroom, in order to locate items. R1 will be receiving assistance from the administrator to organize their bedroom to assist with locating items easier. Based on interviews conducted we are unable to confirm or deny if the allegations occurred. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegations. Therefore, the allegations are deemed unsubstantiated.

An exit interview was conducted with Administrator and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), were provided to the Administrator via electronic mail. An electronic read receipt confirmation was requested to be sent by the Administrator upon receipt of the documents. [See LIC 811 Confidential Names List to identify Resident #1 and Staff #1]

SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021

LIC9099 (FAS) - (06/04)

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