374603755-3-6-2024-08-AS-LTEZ-D3QQBP-20240326120153

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603755
Report Date: 03/06/2024
Date Signed: 03/06/2024 11:49:56 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
04/20/2021 and conducted by Evaluator Dang Nguyen

COMPLAINT CONTROL NUMBER: 08-AS-20210420105842

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: 4	DATE:	03/06/2024
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Caregiver Petra Gelindec and Administrator Raushon Ahmed		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility staff did not afford resident dignity.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit to continue investigation of the above allegation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Petra Gelindec. LPA also spoke with Administrator Raushon Ahmed via phone during today’s visit.

The Complainant alleged Licensee did not afford Resident #1 (R1) dignity because Licensee's staff moved R1’s personal belongings within/inside their bedroom, without R1’s consent.

During today’s visit, LPA briefly toured the facility and interviewed residents in care. CCLD’s investigation also involved a prior unannounced facility tour / welfare check and review of pertinent care and administrative records. The Department also interviewed R1 and relevant staff. [CONTINUED ON LIC 9099-C, 1 of 2]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

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-20210420105842

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: 03/06/2024

NARRATIVE

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[CONTINUED FROM LIC 9099]

Per R1’s LIC602 Physician’s Report, R1’s doctor determined that R1 was not confused/disoriented, able to communicate needs, able to follow instructions, and able to leave the facility unassisted. The doctor also wrote that R1 experienced urinary incontinence and had poor hygiene habits. R1’s LIC603A Resident Appraisal reinforced that they were bladder incontinent. Multiple staff interviews corroborated that R1 sometimes wet their bed, despite wearing pull-up/Depends underwear.

According to regulation CCR 87464 (titled "Basic Services"), Licensee was required to provide “safe and healthful living accommodations.” According to regulation CCR 87307 (titled "Personal Accommodations and Services"), Licensee was required to provide “clean linen” for resident beds and ensure that “clean linen is in use by residents at all times.” According to the Admissions Agreement which R1 signed, R1 was their own responsible person and they agreed to allow Licensee's staff to periodically change their bed linens and provide basic housekeeping to their room.

Staff interviews showed: During the time frame of the complaint, caregivers sometimes entered R1’s room to perform bed linen changes and basic housekeeping when R1 was not present (since R1 frequently went on community outings). There were times cleaning was urgent, due to R1 having wet their bed. R1 often left small personal effects on top of their bed and/or on the floor of their bedroom. To effectively change R1’s bed linens and/or sweep/mop the floor, staff sometimes relocated said personal effects into a cardboard box. The box was left inside R1’s bedroom in plan view for R1 to see upon their return. There was at least one occasion when staff observed the top of R1’s dresser was so filled with personal items that some (which included open containers) were at risk of falling on the ground. Staff similarly placed some of these items in a cardboard box.

Staff interviews aligned to show that on occasions when staff touched R1’s belongings, their scope was limited to only those items which needed to be moved to support basic cleanliness for R1’s room. Cleanliness of R1’s bedroom supported R1’s dignity. Licensee provided open communication to R1 about the need to clean and made reasonable efforts to clean when R1 was present, although this was not always possible.

[CONTINUED ON LIC 9099-C, 2 of 2]

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20210420105842

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: 03/06/2024

NARRATIVE

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[CONTINUED FROM LIC 9099-C, 1 of 2]

In their own interview, R1 confirmed that facility staff did not remove their personal belongings from their bedroom or deprive them access to or use of their belongings. LPA’s observation of R1’s bedroom supported the credibility of staff accounts. LPA also interviewed three (3) additional residents in care; each person said that facility staff treated them with dignity and respected their belongings / personal property.

Based on interviews and records, a preponderance of evidence does not exist to prove that Licensee did not afford R1 dignity. The allegation is therefore unsubstantiated.

An exit interview was conducted with Gelindec and Ahmed. A copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided to Licensee during today’s visit.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

LIC9099 (FAS) - (06/04)

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