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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604485
Report Date: 09/05/2024
Date Signed: 09/05/2024 10:23:46 AM

Document Has Been Signed on 09/05/2024 10:23 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:POWAY ELDER CAREFACILITY NUMBER:
374604485
ADMINISTRATOR/
DIRECTOR:		RATHI, GAURAVFACILITY TYPE:
740
ADDRESS:14846 ESPOLA RDTELEPHONE:
(419) 377-9822
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 6CENSUS: 6DATE:
09/05/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:53 AM
MET WITH:Andrea Sandoval MartinezTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analyst’s (LPA’s) Carmen Lopez and Hanah Rodgers conducted a Case Management visit, to conduct an unannounced health and safety check for residents in care. LPA's identified themselves and were granted entry by Regina Reyes Romero, caregiver. LPA met with caregiver Reyes Romero and disclosed the purpose of the visit. Administrator Nikita Mundhada later arrived and joined the visit.

During a complaint investigation on August 29, 2024, LPA observed that that the front door had the code lock door facing the inside of the facility. The facility was cited on a fire clearance issue during the investigation. LPA spoke with the Licensee Gaurav Rathi and informed them that the code lock would need to face the outside which Licensee ensured was completed. During today’s visit, LPA’s Lopez and Rodgers confirmed that the code locks faced the outside.

No deficiencies were cited during today’s visit.

An exit interview was conducted with Administrator Nikita Mundhada and a copy of this report and Licensee/Appeal Rights (LIC 9058 3/22) were provided to the Administrator at the conclusion of the visit. The signature below confirms the documents were received.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2024
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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