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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604729
Report Date: 03/06/2025
Date Signed: 03/06/2025 12:21:32 PM

Document Has Been Signed on 03/06/2025 12:21 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:LA MESA ELDER CAREFACILITY NUMBER:
374604729
ADMINISTRATOR/
DIRECTOR:		RATHI, GAURAVFACILITY TYPE:
740
ADDRESS:7784 MELOTTE STREETTELEPHONE:
(619) 791-5495
CITY:SAN DIEGOSTATE: CAZIP CODE:
92119
CAPACITY: 6CENSUS: 6DATE:
03/06/2025
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Administrator Jenifer SequeiraTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced quarterly Case Management/Legal Non-Compliance visit. LPA was granted entry by and disclosed the purpose of the visit to
Administrator Jenifer Sequeira.

On January 22, 2025, the Licensee agreed on a compliance plan for the following 24 months through January of 2027. During today’s visit, LPA conducted a general overall inspection of the facility, interviewed staff, reviewed records, and evaluated licensee’s ongoing compliance with the requirements described in the LIC9111.

During the visit, the facility was clean, safe, and in good repair. Records reviewed were current and complete. Staff records reviewed contained required documentations.There were no immediate health or safety concerns. Based upon today’s observation and interviews, the facility was operating consistent with the terms of the compliance conference. No deficiencies were observed or issued as part of this compliance visit.

An exit interview was conducted with Administrator Jenifer Sequeira, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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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