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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604729
Report Date: 01/22/2025
Date Signed: 01/23/2025 08:29:55 AM

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
11/07/2024 and conducted by Evaluator Iby Strong
COMPLAINT CONTROL NUMBER: 08-AS-20241107113808
FACILITY NAME:LA MESA ELDER CAREFACILITY NUMBER:
374604729
ADMINISTRATOR:RATHI, GAURAVFACILITY TYPE:
740
ADDRESS:7784 MELOTTE STREETTELEPHONE:
(619) 791-5495
CITY:SAN DIEGOSTATE: CAZIP CODE:
92119
CAPACITY:6CENSUS: 6DATE:
01/22/2025
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Abhinav Singh, Business Manager TIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Neglect/Lack of Supervision resulted in multiple injuries.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to deliver findings in the above-mentioned complaint allegation. LPA identified herself and discussed the purpose of the visit with Abhinav Singh, Business Manager.

On November 7, 2024, Community Care Licensing (CCL) received a complaint alleging Resident 1 (R1) was observed to have multiple minor injuries. During the investigation, LPA Strong collected pertinent resident records, facility documentation, photographs, video and conducted multiple outside sourced interviews. According to the allegation, R1 was observed to have bruises with unknown causes as of November 4, 2024. R1’s Physician Report signed October 17, 2023, R1 is dependent on a wheelchair, does not require medication management, and is able to communicate need.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
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 2
Control Number 08-AS-20241107113808
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: LA MESA ELDER CARE
FACILITY NUMBER: 374604729
VISIT DATE: 01/22/2025
NARRATIVE
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Interview with staff present on the morning of November 4, 2024, revealed that R1 left the facility to a medical appointment and returned to the facility later that afternoon with multiple minor injuries. Video collected from the facility determined that R1 did not have any injuries as of 8:05 am on November 4, 2024. Staff also revealed that when R1 returned from medical appointment, R1 had minor bruising on the forehead, ear, fingers, and ears. According to pictures reviewed and statements from staff, the bruises became larger and darker as time progressed. Interview with Outside Source 1 (OS1) revealed that there was an external investigation and found no further explanation of injuries to R1. Interview with Outside Source 2 (OS2) established that the medical transport was also investigated and found no facts to determine how R1 was injured. Interview with Outside Source 3 (OS3) did not reveal any additional information to determine cause of injuries. Lastly R1 was unable to explain injuries to facility staff, Administrator or Licensing Program Analyst.

Based on multiple interviews, record reviews, photographs, and video there is not a preponderance of evidence to prove alleged violations occurred, therefore the allegations are unsubstantiated. An exit interview was conducted with Abhinav Singh, Business Manager, to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2