Safe Harbor Elder Care

Type of visit: Required - 1 Year

On 03/19/26, Licensing Program Analyst (LPA) Aziz Faizi made an unannounced visit to the facility to conduct a required annual inspection. LPA was greeted and granted entry by caregiver Veronica Zavala who was informed of the purpose of the visit. Administrator Nikita Mundhada was informed through phone call of the purpose of the visit and arrived at a later time. The facility is a one story home with six (6) bedrooms, two (2) full bathrooms and one (1) half bathroom with an attached garage. No pools or firearms are being kept at the facility. LPA toured the facility's exterior and observed outdoor pathways were free of obstructions. Outdoor shaded seating area is available for the clients in care. The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. LPA toured the kitchen and observed the facility has a two-day supply of perishable foods and more than a seven-day supply of non-perishable foods, which are stored in a safe and healthy manner. LPA observed knives and sharp instruments secured in locked kitchen cabinet. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 106.1°F. Fire extinguisher located in the kitchen meeting department's requirements expiring 01/03/2027. Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate expiring 10/03/2026. LPAs reviewed files for two (2) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Two (2) resident files were reviewed and contained all required documentation. All resident medications were securely locked. LPA reviewed medications for two residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. LPAs reviewed the facility’s emergency and disaster plan, including documentation of the last fire/earthquake drill conducted on 01-22-2026, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed and provided.the state’s words, verbatim · CDSS document, Mar 19, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced Case Management Visit to the facility. LPA met with and was granted entry by staff and later met with Administrator who were informed of the purpose of the visit. At the time of the visit there were (4) residents and (3) staff present. LPA conducted a walk through of the facility, observed residents in care, food supply, working utilities. LPA checked criminal record clearance for staff present during the visit. (1) staff was not associated to the facility, the Administrator associated the staff during the time of the visit and LPA verified the staff clearance during the time of the visit. Therefore, a deficiency was issued for not associating the staff prior to staff starting to work at the facility. As of 1/22/2025 the facility hospice waiver has been revoked and exceptions are required to retain hospice residents. Per resident's LIC602 Physician's Reports and Administrator Interview no residents are currently on hospice services. As of 1/22/2025 the Licensee agreed to obtain outside source training to all staff every quarter and provide proof of training documentation regarding the following topic: Basic Services, Personnel Requirements, Personal Rights, and Allowable Health Conditions and Managed Incontinence. LPA reviewed the training was last conducted in September 2025 and January of 2026 through an outside source. No health or safety issues were observed during the time of the visit. An exit interview was conducted with staff were this report was reviewed and provided.the state’s words, verbatim · CDSS document, Feb 18, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87355(e)(3) · Plan of correction due date: Feb 18, 2026

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review...shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c)...This requirment was not met as evidenced by: Based on interview with administrator, observation of staff working, and record review of facility Guardian roster (1) staff was not transfered to the facility roster prior to working at the facility. This poses a potential health saftey or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 18, 2026

Plan of correction: During the time of the visit LPA verified the criminal record clearance for staff and the administrator associated the staff during the time of the visit. Therefore, the deficency was cleared at the time of the visit.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced Case Management Visit to the facility. LPA met with and was granted entry by staff and later met with Administrator who were informed of the purpose of the visit. The licensee was available during the visit, and then over the phone. At the time of the visit there were (4) residents and (3) staff present. LPA conducted a walk through and a visual check on the residents in care. (1) staff present during the visit did not have a criminal record clearance, and based on interviews has been working for more than (5) days at the facility. The staff was escorted of the premises and a deficiency was issued on the Annual Visit report which was conducted on today's date. No other health or safety issues were observed during the time of the visit. An exit interview was conducted with staff were this report was reviewed and provided. The licensee and the administrator did not agreed with the assessment of the deficiency and refused to sign the report.the state’s words, verbatim · CDSS document, Mar 14, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with Administrator, Nikita Mundhada who was informed of the purpose of the visit. At the time of the visit there was (3) staff and (4) residents present. The facility is a one story home with (4) bedrooms and (2) and a half bathrooms with attached garage. No pools or firearms are being kept at the facility. Infection Control: The LPA observed hand washing stations in the restrooms and kitchen, hand hygiene supplies and personal hygiene items for residents. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements. Physical Plant: LPA observed the client bedrooms. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. The sharp and dangerous objects were observed to be locked and inaccessible to clients in pantry closet. The smoke detector and carbon monoxide was operational, and the hot water temperature 115.3F. Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. Care & Supervision/Administration: Adequate staff are present for the supervision of clients during the visit. LPA also reviewed the staff scheduled showing adequate staff coverage. Required postings were found in the facility. The listed administrator, possesses a current administrator's certificate. Record Review and Resident/Staff Files: LPA reviewed (4) staff files and training. All staff have updated training along with CPR/First Aid Certification and required documents. LPA reviewed the Guardian roster, staff file and conducted interview with the Administrator which revealed (1) staff has been fingerprinted twice on 9/17/2024, and again on 2/3/2025 but did not receive a clearance from the department prior to working at the facility. Therefore a deficiency was cited and a civil penalty was issued. (4) client files were reviewed, and possessed all required paperwork. Health Related Services/ Incidental Medical Services: All client medication was locked in closet. LPA reviewed client medications for (2) client and found all medication listed on MARS and accounted for. Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing the facility's last fire drill 12/16/2024. A technical note was issued for the licensee to document the names of staff participating in the drill. LPA observed all facility exits were clear from obstructions. LPA observed emergency supplies in the and first aid kit. An exit interview was conducted where this report was reviewed and provided. The licensee and the administrator did not agreed with the assessment of the deficiency and refused to sign the report.the state’s words, verbatim · CDSS document, Mar 14, 2025

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Facility staff recorded resident without consent

Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced visit to conclude the complaint investigation regarding the allegation listed above. LPA was granted entry and met with Administrator Nikita Mundhada who was informed of the purpose for the visit. The investigation consisted of observations, interviews, and records review. Regarding the allegation “Facility staff recorded resident without consent”, it was reported photographs and videos were taken of Resident One (R1) by staff without R1’s consent. Interview conducted with R1 revealed R1 has told staff they do not want to be recorded or have their picture taken. Interview with Administrator Nikita Mundhada revealed photos and recordings are taken of R1 and the residents to document incidents and injuries so they can send the recordings or photos to R1’s medical team and social worker at Program of All-Inclusive Care for the Elderly (PACE). Record review of R1’s Physician’s Report documents R1 is able to communicate their own needs. Substantiated Record review of R1’s Admissions Agreement has a “Consent to Photograph” section signed by R1 in which authorizes “photographing portions of resident’s body to document skin condition”. Interview with staff reported they ask R1 and the other residents for their consent prior to taking a photo or recording so they can send it to Administrator Mundhada. Interview with residents reported witnessing staff take pictures of R1 after R1 had verbally told staff “no”. Based on LPA’s interviews and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation(s) is/are found to be substantiated. California Code of Regulations (Title 22, Division 06, Chapter 08), are being cited on the attached LIC 9099 D. An exit interview was conducted and a copy of this report, deficiency page LIC 9099-D, LIC 811, and appeal rights was provided to Administrator Mundhada. S1 denies leaving R1 on the floor on 11/04/2024 for an extended amount of time and had notified S2 and Administrator Mundhada of the unwitnessed fall to provide R1 with assistance. S1 reported R1 is a two person assist and staff also utilize a Hoyer lift to assist R1. Interview with S1 and Staff Two (S2) revealed they do not leave residents on the floor after a fall for an extended amount of time. Interview with staff reported when a resident has an unwitnessed fall, they assess the resident for injuries. If emergency medical services are needed, the staff will notify Administrator Mundhada and contact 911. Interview with two (2) additional residents reveal they have witnessed S1 and additional staff help assist R1 when they fall and have never observed R1 on the floor for an extended amount of time. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted and a copy of this report and LIC 811 was provided to Administrator Mundhada.the state’s words, verbatim · CDSS document, Nov 22, 2024 · control 18-AS-20241107094027

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Nov 29, 2024

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1)To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement has not been met as evidence by: Based on interviews and record review, Licensee did not ensure Resident One (R1)'s personal rights when taking a photograph or recording of R1 with their consent which poses a personal rights, health, and safety risk to the residents in care.the state’s words, verbatim · CDSS document, Nov 22, 2024

Plan of correction: Licensee will ensure staff are trained and understand the Personal Rights of the residents and will submit proof of staff training to LPA by the plan of correction date 11/29/2024. Licensee reported they staff will no longer take photos of R1.

Allegation investigated: Staff hit a resident

Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced visit to conclude the complaint investigation regarding the allegation listed above. LPA was granted entry and met with Administrator Nikita Mundhada who was informed of the purpose for the visit. The investigation consisted of observations, interviews, and records review. Regarding the allegation “Staff hit a resident”, it was alleged a staff member (S1) had smacked Resident One (R1) on their left hip. LPA’s interview with R1 revealed S1 had entered R1’s room to check on R1 during the night and “smacked me”. R1 reported they feel safe with S1 and R1 is not sure if the smack was intentional or an accident. R1 revealed they did not report the incident with S1 to Administrator Nikita Mundhada because they forget about the incident. LPA interviewed S1 who denied hitting R1 or the other residents in care. S1 reported they have not witnessed other staff members hit R1 or the other residents in care. Interview with Staff Two (S2) reported they did not witness S1 hit R1 or the other residents in care. Unsubstantiated LPA conducted interviews with two (2) residents who reported they feel safe with S1 and the other staff members. Resident interviews revealed they have not witnessed S1 or the other staff hit R1 or the other residents in care. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted and a copy of this report and LIC 811 was provided to Administrator Nikita Mundhada.the state’s words, verbatim · CDSS document, Nov 22, 2024 · control 18-AS-20241108083534

Allegation investigated: Licensee did not follow physician's orders Licensee violated resident's personal rights Licensee did not provide staff with the appropriate training Licensee did not provide adequate supervision, resulting in residents sustaining multiple injuries Licensee does not properly assess the resident's needs, resulting in lack of care Licensee's food supply is not of good quality

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced complaint visit to deliver investigative findings. LPA met with Administrator, Nikita Mundhada. The Department investigated the above-listed complaint allegations. The investigation consisted of observations, a review of relevant records, and interviews with residents, facility staff, and outside sources. On September 25, 2020, Community Care Licensing (CCL) received a complaint alleging that the licensee did not follow physician’s medication orders. It was specifically alleged that staff were not administering medications as prescribed. In addition, it was alleged that staff were taking residents’ medications for their personal use. The dates and/or times when staff did not administer medication as prescribed were not identified during the investigation. (Continue at LIC-9099C) Unsubstantiated (Continue from LIC9099) During multiple interviews with residents, staff, and outside sources it was consistently indicated that the residents were administered their medications according to their physician’s orders. A detailed review of the medication administration records from August 1, 2020, to September 10, 2020, for the six (6) residents disclosed no discrepancies of missing doses. In addition, the Department was unable to obtain credible information from records review, interviews with staff, and outside sources of when staff acquired residents' medication for their personal use. It was alleged that the licensee violated the resident’s personal rights. It was specifically alleged that there was one incident when a staff member yelled at a resident. The date/time of when this incident occurred was not obtained during the investigation. Multiple interviews with staff, residents, and outside sources consistently indicated that staff treated residents with respect, and none had observed, heard, or witnessed any staff member yelling or mistreating any of the residents. During interviews, facility management stated that no resident had expressed any concerns regarding staff mistreating any of the residents. It was alleged that the licensee did not provide staff with the appropriate training. Details of the type of training or which staff did not receive appropriate training were not obtained during the investigation. During interviews, facility staff confirmed that they had all received the required training in personal rights, reporting requirements, and all other training as required per Title 22 regulations. A review of a sample of staff training records indicated no violations of Title 22 training requirements, all staff completed the required initial training and annual training. It was also alleged that the licensee did not provide adequate supervision, resulting in residents sustaining multiple injuries. It was specifically alleged that there was insufficient staff to meet the needs of the residents. Multiple interviews with staff, residents, and outside sources revealed no staffing concerns. A detailed review of staff schedules from August 1, 2020, to September 1, 2020, indicated that at least three (3) staff were scheduled during the morning and afternoon shifts, and at least one (1) staff was scheduled during the overnight shift. In addition, during interviews with staff and outside sources, it was consistently indicated that they were not aware of any resident sustaining multiple injuries due to lack of supervision. A detailed review of facility records indicated no unreported incident reports regarding residents’ injuries. (Continue at LIC9099C) (Continue from LIC9099C) It was also alleged that the licensee did not properly assess the resident's needs, resulting in lack of care. Details of when or which resident was not properly assessed were not obtained during the investigation. A detailed review of residents’ service care plans and relevant resident records indicated that all residents' assessments were completed as required by Title 22 regulations, at the time of admission, annually, and/or when there was a change in medical condition. The Department was unable to obtain credible information from resident interviews or outside sources corroborating this allegation. Lastly, it was alleged that the licensee's food supply was not of good quality. It was specifically alleged that staff were serving expired food to residents. The dates/times of when this occurred were not disclosed during the investigation. During interviews with residents, staff and outside sources indicated that the food was of good quality and met residents’ food service needs. The Department has investigated the above-mentioned allegations and based on interviews and records review, the preponderance of the evidence has not been met, therefore, these allegations are deemed unsubstantiated. An exit interview was conducted with Administrator, Nikita Mundhada, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 03/22) was provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Mar 21, 2024 · control 08-AS-20200925145400

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On March 12, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the Required Annual Inspection and met with the Administrator. The facility file review was conducted in the office and additional forms were reviewed and requested on site. The facility is operating at the capacity of five residents but licensed for six. LPA Mixson toured the facility along with the Administrator, and inspected the facility inside and outside, and there were no obstructions to the indoor or outdoor passageways at the time of this visit. The facility is a single-story home located at 3301 Lomas Serenas Dr, Escondido, CA. 92029. Physical Plant: The facility phone number is (619) 791-5495 and is operable. The LPA observed the residents’ bedrooms, and each was equipped with required furniture as per Title 22. LPA Mixson inspected facility bathrooms, and the hot water temperature tested within regulations. The bathrooms were clean, and appliances were operating appropriately currently at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguisher. The LPA observed required postings such as "If you See Something, Say Something" the "Personal Rights" and the Ombudsman postings. The cleaning supplies and sharp items were kept locked and inaccessible to the residents in care. There was a designated storage space for the residents and staff files were kept in the cloud, and it was locked and inaccessible to residents in care currently at the time of this visit.Medications: were locked and inaccessible to residents, and there was a sufficient supply of medication for residents in care. The overall facility is clean, the furniture is in good condition. The facility heating system and other appliances were operable currently at the time of this visit. Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents. Dishes and utensils were in sufficient supply and stored properly. Care & Supervision: Facility has sufficient staff, two staff, and Administrator on site at the time of this visit. Records Review: The LPA reviewed resident and staff files, and conducted staff and resident interviews. Previous Community Care Licensing forms were reviewed. There were no Title 22, Division 6 Regulation violations observed or cited during today’s visit. An exit interview was conducted, and a copy of this report was given to the Administrator, Nikita Mundhada.the state’s words, verbatim · CDSS document, Mar 12, 2024