374604586-4-22-2026-08-AS-APAO-DTLQ4K-20260429115024

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604586
Report Date: 04/22/2026
Date Signed: 04/22/2026 06:35:07 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
12/26/2025 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20251226115615

FACILITY NAME:	ELDERLY HAVEN		FACILITY NUMBER:	374604586
ADMINISTRATOR:	AKHTER-RAHMAN, SYEEDA SELI		FACILITY TYPE:	740
ADDRESS:	10163 EMBASSY WAY		TELEPHONE:	(858) 935-9062
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92126
CAPACITY:	6	CENSUS: 6	DATE:	04/22/2026
		UNANNOUNCED	TIME BEGAN:	05:45 PM
MET WITH:	Licensee, Dr. Mohammad Rahman		TIME COMPLETED:	05:50 PM

ALLEGATION(S):

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Neglect, resulting in delayed medical care
Staff did not meet resident's hygiene needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced visit to conclude a complaint investigation regarding the above mentioned allegations. LPA met with Licensee, Dr. Mohammad Rahman .

During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff, residents, and outside sources. It was alleged Resident #1 (R1) was neglected, resulting in delayed medical care and staff didn’t meet R1’s hygiene needs. R1’s Preplacement Appraisal dated 12/16/25 indicated R1 was unable to get up due to severe pain. It also stated R1 always wanted to call 911 when in pain and wanted to receive their hip surgery. The report reflected R1 required assistance with bathing, hair care, and personal hygiene. It was reported that R1 was transferred on 12/17/25 from a Skilled Nursing Facility (SNF) to this facility, while awaiting hip replacement surgery. On 12/20/25, R1 called 911 due to hip pain. Staff reported not being aware of the call and paramedics suddenly arrived at the facility. Continued on LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026

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 3

Control Number 08-AS-20251226115615

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ELDERLY HAVEN	FACILITY NUMBER: 374604586
	VISIT DATE: 04/22/2026

NARRATIVE

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Staff stated they were advised by the paramedics that R1 required permission due to the resident contacting 911 themselves. Staff called R1’s responsible party to obtain permission but could not get hold of them. R1’s responsible party reported receiving calls from an unknown number, and the person calling was speaking a different language. Therefore, no contact with facility staff was made. Staff explained that the paramedics did not transport R1 to the hospital. The following day, R1’s responsible party was made aware R1 was still having pain and arranged transport to the hospital.

R1 was experiencing pain upon admission to the facility and awaiting the hospital to schedule their hip surgery. A review of facility records reflected on 12/17/25, R1 signed the facility’s Consent For Emergency Medical Treatment form. The form provides consent on behalf of the facility for the residents. R1 reported they called 911 because they were in pain. R1 admitted they didn’t alert staff that they contacted 911. R1 stated they explained to the paramedics they were in pain and awaiting surgery. The paramedics stated there wasn’t a medical need to take R1 to the hospital. R1 said the paramedics explained the transport was costly. Therefore, that was the reason staff contacted R1’s responsible party to clarify if the responsible party would pay for the transport. R1 declined the transport due to the paramedics stating there wasn’t a medical need and the cost being high. The paramedics are trained health professionals and make decisions on transporting individuals requiring care. The paramedics did not observe a medical need to transport R1. Conflicting statements were made regarding delayed medical care.

It was also alleged that staff did not meet R1’s hygiene needs by not providing grooming/hygiene and assistance with brushing R1’s teeth. It was also reported that R1 was not clean when arriving at the facility from the SNF. In addition, R1’s responsible party asked the facility staff to wash R1's feet, shave their face, and do a general clean up. The following day, R1 was not provided with their hygiene needs, as requested. Staff interviews stated R1 was at the facility for a few days but was kept clean and they were not asked to clean or shave R1. Staff added they ensure residents receive their hygiene needs. Staff also recalled R1 as being independent with brushing their teeth. R1 confirmed they are able to brush their own teeth, if they are provided with their items. R1 also stated they were at the facility briefly but were kept clean by staff. Conflicting statements were made regarding hygiene needs being met. Continued on LIC 9099C.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20251226115615

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ELDERLY HAVEN	FACILITY NUMBER: 374604586
	VISIT DATE: 04/22/2026

NARRATIVE

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During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegations. The allegations are deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Licensee, Dr. Mohammad Rahman via email.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026

LIC9099 (FAS) - (06/04)

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