374604485-3-18-2025-08-AS-SJAB-DEXUAX-20250320152525

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604485
Report Date: 03/18/2025
Date Signed: 03/18/2025 07:09:23 PM

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
02/13/2025 and conducted by Evaluator Dang Nguyen

COMPLAINT CONTROL NUMBER: 08-AS-20250213114415

FACILITY NAME:	POWAY ELDER CARE		FACILITY NUMBER:	374604485
ADMINISTRATOR:	RATHI, GAURAV		FACILITY TYPE:	740
ADDRESS:	14846 ESPOLA RD		TELEPHONE:	(419) 377-9822
CITY:	POWAY	STATE: CA	ZIP CODE:	92064
CAPACITY:	6	CENSUS: 6	DATE:	03/18/2025
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Co-Administrator Nikita “Nikky” Mundhada		TIME COMPLETED:	07:15 PM

ALLEGATION(S):

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Licensee did not give resident nutritional supplement as prescribed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit to deliver a finding regarding the above prior complaint allegation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Victor Loera. LPA then met and discussed the purpose of the visit with Co-Administrator Nikita “Nikky” Mundhada, who arrived shortly after.

The Complainant alleged that Licensee did not give Resident #1 (R1) their nutritional supplement as prescribed. CCLD’s investigation involved a welfare check on R1, multiple unannounced facility visits/tours, and interviews of relevant facility staff, residents, and outside sources. The Department also reviewed pertinent facility care records, outside medical records, and E-mail correspondence regarding R1’s care.

[CONTINUED ON LIC 9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025

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-20250213114415

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: POWAY ELDER CARE	FACILITY NUMBER: 374604485
	VISIT DATE: 03/18/2025

NARRATIVE

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[CONTINUED FROM LIC 9099]

During the complaint allegation time frame, R1 was being followed by an outside healthcare management agency. R1’s primary care physician (PCP), dietician, and other medical professionals were based at this agency. The Complainant claimed that on 01/16/2025, PCP changed R1’s order/prescription for Glucerna nutritional supplement from one (1) bottle per day to two (2) bottles per day. They said that from 01/16/2025 through 02/12/2025, there were days Licensee gave R1 one (1) bottle instead of the prescribed two (2).

Interviews of facility manager and multiple caregivers unanimously showed: As of the commencement of CCLD’s investigation on 02/20/2025, all staff were under the impression that R1 was supposed to receive just one (1) bottle of Glucerna per day in the evening, to be given only if their blood sugar was less than 300 mg/dL. All staff interviewed said they were following this order. All staff interviewed also denied the existence of an order for R1 to take two (2) bottles of Glucerna per day.

LPA reviewed dated and time-stamped electronic orders from R1’s healthcare management agency, which showed: Prior to the complaint allegation time frame, R1 was indeed prescribed just (1) bottle of Glucerna per day, to be given only if their blood sugar was less than 300 mg/dL. While R1 did undergo a nutritional reassessment by their dietician on 01/15/2025, the evidence did not show that there was yet an active doctor’s order changing their Glucerna regimen during the complaint allegation time frame, let alone that such an change order (if it even existed then) was successfully transmitted/communicated to Licensee during the complaint allegation time frame. Rather, the healthcare management agency's first electronic recording of the doctor's order to increase R1’s Glucerna to two (2) bottles per day appeared several days after CCLD commenced its complaint investigation. Facility staff followed this later order, as soon as it was received.

Based on records and interviews, a preponderance of evidence does not exist to show that Licensee did not give R1 their nutritional supplement as prescribed. The allegation is therefore Unsubstantiated, and no deficiency was cited for it.

An exit interview was conducted with Co-Administrator Nikita “Nikky” Mundhada, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025

LIC9099 (FAS) - (06/04)

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