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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604277
Report Date: 03/14/2025
Date Signed: 03/14/2025 01:04:22 PM

Document Has Been Signed on 03/14/2025 01:04 PM - 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:SAFE HARBOR ELDER CAREFACILITY NUMBER:
374604277
ADMINISTRATOR/
DIRECTOR:		RATHI, GAURAVFACILITY TYPE:
740
ADDRESS:3301 LOMAS SERENAS DRIVETELEPHONE:
(858) 935-8818
CITY:ESCONDIDOSTATE: CAZIP CODE:
92029
CAPACITY: 6CENSUS: 6DATE:
03/14/2025
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Administrator, Nikita MundhadaTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced Case Management Visit to the facility. LPA met with and was granted entry by staff and later met with Administrator who were informed of the purpose of the visit. The licensee was available during the visit, and then over the phone. At the time of the visit there were (4) residents and (3) staff present.

LPA conducted a walk through and a visual check on the residents in care. (1) staff present during the visit did not have a criminal record clearance, and based on interviews has been working for more than (5) days at the facility. The staff was escorted of the premises and a deficiency was issued on the Annual Visit report which was conducted on today's date. No other health or safety issues were observed during the time of the visit.

An exit interview was conducted with staff were this report was reviewed and provided. The licensee and the administrator did not agreed with the assessment of the deficiency and refused to sign the report.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2025
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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