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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603755
Report Date: 10/19/2021
Date Signed: 10/21/2021 08:36:25 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
01/06/2021 and conducted by Evaluator Natasha Persaud
COMPLAINT CONTROL NUMBER: 08-AS-20210106114530
FACILITY NAME:FAHIMA CARE HOME 1FACILITY NUMBER:
374603755
ADMINISTRATOR:RAUSHON AHMEDFACILITY TYPE:
740
ADDRESS:8554 CAPRICORN WAYTELEPHONE:
(858) 800-7455
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY:6CENSUS: 3DATE:
10/19/2021
UNANNOUNCEDTIME BEGAN:
01:31 PM
MET WITH:Administrator, Raushon AhmedTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff yelled at resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to conclude a complaint investigation. LPA identified herself and discussed the allegation mentioned above with Administrator, Raushon Ahmed.

During today's visit, LPA briefly toured the facility, observed residents in care and interviewed staff. It was alleged Staff #1 (S1) yelled at Resident #1 (R1) for leaving the facility on a daily basis. It was reported S1 yelled at R1 because S1 was concerned R1 was going to go out into the community and might contract Covid-19 and bring it back to the facility. Interviews revealed staff is not yelling at R1 but S1's voice is loud and stearn. S1's interview revealed they were not yelling at R1 but expresing concern while out in the community to ensure to take precautions to prevent contracting the virus. Staff and resident interviews confirmed they have not witnessed S1 yell at R1 or any other residents. Based on interviews conducted we are unable to confirm or deny if staff yelled at resident. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. Therefore, the allegation is deemed unsubstantiated. 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)
Page: 1 of 2
Control Number 08-AS-20210106114530
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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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)
Page: 2 of 2