Sunset Cliffs Elder Care

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Janet Ngallo conducted an unannounced quarterly Case Management/Legal Non-Compliance visit. LPA was granted entry by and disclosed the purpose of the visit to caregiver Albany Gonzalez. Administrator Travonna Washington later joined the visit. 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 were consulted regarding care and supervision practices, including staff responsibilities under Title 22, Section 87468.2 (Additional Personal Rights). No deficiencies were observed or issued as part of this compliance visit. An exit interview was conducted with Administrator Travonna Washington, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Jun 25, 2026

Allegation investigated: Unqualified staff are providing wound care to a resident in care. Licensee retained a resident with a prohibited condition.

Licensing Program Analyst(LPA) Janet Ngallo conducted a telephone visit to conclude and deliver findings regarding the above mentioned allegations. LPA discussed the complaint with Nikki Mundhada. On 07/16/2024, it was alleged that unqualified staff provided wound care to a resident in care and that the Licensee retained a resident with a prohibited condition. The department's investigation consisted of unannounced facility visits, interviews, and records review. Regarding the allegation that unqualified staff provided wound care, interviews reported only replacing a dressing when it became wet or loose, as directed by the resident’s outside care team, while licensed professionals from hospice or the care team were responsible for actual wound care. Records review of R1's hospice care plan initiated on 07/17/2024 revealed that hospice is to perform wound care 3 times a week. (Cont. on LIC 9099-C) Unsubstantiated (Cont. from LIC 9099) Regarding the allegation that the licensee retained a resident(R1) with a prohibited condition, interviews revealed that R1 arrived unexpectedly during the evening of 07/15/2024 with multiple wounds, and facility staff immediately contacted the on-call nurse and the discharging social worker to clarify expectations for care. Interviews with R1's outside care team stated that the hospital discharged R1 prematurely, due to hospital practices to discharge within a three-day window or as soon as medically stable, even when a resident requires a higher level of care. Interviews with R1's care team further revealed that the hospital recommended that R1 go back to assisted living under hospice services or skilled nursing facility, however R1's responsible parties declined and requested that the resident return to the facility. Interviews revealed that upon the resident’s arrival, facility staff immediately contacted the care team and sought guidance. The resident was subsequently enrolled in hospice, and skilled wound care was assigned to outside licensed providers. Records revealed that R1 was discharged from the hospital on 07/15/2024 and hospice did not begin providing oversight until the evening of 07/17/2024. Records review of email correspondence from the facility administrator on the evening of 07/15/2024 showed immediate communication with R1's care team, documenting R1’s arrival condition, the discovery of an unstageable wound, and coordination to determine how often the care team or home-health nurses could visit to address wound care. Additional email correspondence from the next morning, 07/16/2024, summarized the Administrator’s call with the care team, clarifying that the facility had not been informed of the discharge, had refused to accept the resident until receiving a revised 602, and reiterated that the facility could not provide skilled wound care and would follow R1's care team and hospice directives. The Administrator emphasized collaboration with the care team and expressed full support for placement in a skilled nursing facility if the care team determined it was appropriate. Based on interviews and records review, the preponderance of evidence standard has not been met, therefore the above allegations are found to be unsubstantiated. An exit interview was conducted with Administrator Nikki Mundhada and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), were provided via email.the state’s words, verbatim · CDSS document, Apr 22, 2026 · control 08-AS-20240716154743

Allegation investigated: Staff are not able to communicate effectively with resident and resident's responsible party. Staff does not provide activities for resident. Staff do not transfer resident in a safe manner. Staff are not adhering to resident's dietary needs.

Licensing Program Analyst(LPA) Janet Ngallo conducted an unannounced subsequent visit to deliver findings regarding the above-mentioned complaint allegations. LPA introduced themselves and disclosed the purpose of the visit and elements of the complaint to Administrator Travonna Washington. On 02/05/2026, it was alleged that staff are not able to communicate effectively with resident and resident's responsible party, staff does not provide activities for resident, staff do not transfer resident in a safe manner, and that staff are not adhering to resident's dietary needs. The department's investigation consisted of unannounced facility visits, observations, interviews, and records review. (Cont. on LIC 9099-C) Unsubstantiated (Cont. from LIC 9099) Regarding the allegation that staff are not able to communicate effectively with Resident 1(R1) and R1's responsible party, interviews did not corroborate the allegation. Staff reported that a staff member (S1) utilizes a translation application when communicating with residents and their families. Staff explained that S1 is able to communicate basic words independently, such as directing residents to routine care tasks, and will seek assistance from another staff member when more detailed communication is required. Staff further reported that S1 performs their duties effectively, and any minor communication gaps are addressed through consistent use of the translator app. During an unannounced visit, LPA observed S1 using a translation application to communicate with the LPA, demonstrating the method described during interviews. Regarding the allegation that staff does not provide activities for R1, interviews reported that staff provide daily activities such as coloring, arts and crafts, ball play, board games, and range-of-motion exercises. Staff explained that while R1 is unable to fully participate in many structured activities due to R1’s condition, staff consistently offer individualized engagement, including taking R1 outside for fresh air, providing range-of-motion exercises, offering fidget items and simple coordination tasks, and speaking with R1 throughout the day. Staff stated that they have attempted activities requested by R1’s responsible party, however, R1 does not have the physical capacity to complete several of these tasks, and activities are adjusted based on R1’s abilities. Records review of R1’s Needs and Services Plan reflects that R1 requires total assistance with activities of daily living and that staff are to provide routine range-of-motion exercises, supervised outdoor time, and daily supervised social engagement consistent with what was described during interviews. Regarding the allegation that staff do not transfer resident in a safe manner, interviews did not corroborate the allegation, as staff reported that they are trained to use a facility Hoyer lift and have used it for R1, particularly after R1’s responsible party expressed a preference for transfers to be completed with the lift. Interviews indicated that R1 has consistently had a two-person assist since admission, and although staff initially attempted transfers without the lift during the first days of R1’s stay, they began using the Hoyer lift once this preference was communicated. Staff stated that the lift is kept accessible in the hallway due to limited space in R1’s room. (Cont. on LIC 9099-C pg. 1) (Cont. from LIC 9099-C) Records review revealed that R1’s Needs and Services Plan requires a two-person assist for mobility and transfers, and R1’s Physician’s Report indicates a need for maximum assistance. During an unannounced visit, LPA Ngallo observed a Hoyer lift present in R1’s room. Regarding the allegation that staff are not adhering to resident's dietary needs, interviews reported that staff follow R1’s prescribed minced-and-moist diet and have been preparing foods consistent with R1's medical provider's guidance. Staff stated they mince foods finely, add moist components such as mayonnaise, separate items when requested, and adjust textures based on R1’s chewing ability. Staff also reported ongoing communication with R1’s responsible party, sending pictures of R1's food frequently to ensure accuracy. Records review of R1’s Needs and Services Plan and Physician’s Report showed that R1 requires a soft/minced/moist diet with thin liquids. Records review of text and email correspondence revealed numerous photos of R1’s meals, demonstrating foods chopped into fine pieces with moist mixtures. Based on interviews, observations, and record review, the preponderance of evidence standard has not been met, therefore the above allegations are found to be unsubstantiated. An exit interview was conducted with Administrator Travonna Washington and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), were provided. Their signature confirms receipts of these documents.the state’s words, verbatim · CDSS document, Apr 1, 2026 · control 08-AS-20260205113001

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA)Janet Ngallo conducted an unannounced case management visit to cite deficiencies observed during a complaint visit. LPA identified herself to, was greeted by, and explained the purpose of the visit to Facility Manager Vinny Rathi. During the visit, LPA observed an audio monitoring device located in the common area. Staff reported that the device has an audio component that is primarily used for audio to pick up sounds in residents rooms during night shifts. One deficiency was cited per California Code of Regulations Title 22 for surveillance with an audio component and noted on the attached LIC809-D page. An exit interview was conducted with Facility Manager Vinny Rathi, whose signature below confirms receipt of a copy of this report, and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Jan 23, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a) · Plan of correction due date: Jan 30, 2026

87468.2 (a) "…residents... shall have all of the following personal rights: (1) To have a reasonable level of personal privacy…" This requirement was not met as evidenced by: Based on LPA observation and interview, the licensee did not comply with the section cited above in that audio surveillance in the common areas of the facility were observed. This poses a potential personal rights risk to 6 of 6 residents in care.the state’s words, verbatim · CDSS document, Jan 23, 2026

Plan of correction: Licensee to remove the camera/audio recording devices from the facility and to provide outside vendor personal rights training for all staff, including the licensee. Documentation of the training will include a sign-in sheet with participant names and the training topic clearly noted. Proof of completion due by 01/30/2026.

Allegation investigated: Resident sustained unexplained injury due to neglect/lack of supervision. Staff left resident in a soiled diaper for an extended period of time. Staff did not shower resident in care. Staff did not report resident's incident to the resident's authorized representative.

Licensing Program Analyst(LPA) Janet Ngallo conducted an unannounced subsequent visit to deliver findings regarding the above-mentioned complaint allegations. LPA introduced themselves and disclosed the purpose of the visit and elements of the complaint to facility manager Vinit Rathi. On October 20th, 2025, it was alleged that a resident sustained an unexplained injury due to neglect/lack of supervision, staff left resident in a soiled diaper for an extended period of time, staff did not shower resident in care, and staff did not report resident's incident to the resident's authorized representative . The department's investigation consisted of unannounced facility visits, interviews with facility staff, attempted interviews with outside sources, and records review. Regarding the allegation that a resident sustained an unexplained injury due to neglect/lack of supervision, staff members were interviewed regarding the allegation. Staff interviews did not support the allegation as staff stated the resident was presumed to have had an unwitnessed fall based on a bruise observed during a morning shower. (Cont. on LIC 9099-C) Unsubstantiated (Cont. from LIC 9099) The resident was found lying in the middle of the bed with water on the floor but the bed dry. Staff did not suspect a fall because the resident typically requires assistance to get out of bed and was found on the bed when checked. Staff consistently stated that they conduct routine checks every 1–2 hours overnight and use sound monitors, which function similarly to baby monitors. These devices allow staff to hear sounds coming from residents’ rooms during the night so they can respond promptly if additional assistance is needed. Attempts were made on several occasions to interview outside sources, including R1’s Power of Attorney (POA); however, no contact was successfully established during the investigation. LPA attempted to interview R1, however due to R1’s major neurocognitive disorder they were not able to be qualified for interview. During an unannounced facility visit, LPA observed R1’s room with clean sheets, clean floors, and free of hazards. R1 was observed asleep, clean and well-groomed. Pool noodles were observed attached to the bed rails for injury prevention while residents are sleeping. Staff explained that residents may toss and turn during the night and could hit their heads on the rails; the pool noodles are used as padding to reduce the risk of injury. This modification does not interfere with the intended purpose of the bed rails, which is to assist residents with mobility. A camera with a posted 'camera in use' notice was observed in the room, installed by R1’s POA for additional monitoring. Review of facility records corroborated staff interviews. R1's Plan of Care, LIC 602, Needs and Services Plan, and Resident Appraisal, reflects that R1 requires one-person assistance for all ADLs and needs frequent reminders for toileting. R1 is ambulatory with assistance or walker, and has some visual impairment. Records confirm reduced mobility and frequent confusion, due to dementia. The incident report was consistent with staff statements as staff documented that they found R1 on their bed with legs hanging off the edge, pants removed, and assumed urine on the floor. The incident was unwitnessed, and it was unclear whether a fall occurred as R1 did not express pain or discomfort, and was found on the bed, not the floor. The facility consulted a physician and nursing staff following the incident. R1's diaper check logs revealed routine checks throughout the day and every two hours overnight, including the day of the incident that occurred. Records did not give evidence that R1 was not being supervised according to their care plan and routine checks during the time of incident. (Cont. on LIC 9099-C pg. 1) (Cont. from LIC 9099-C) Regarding the allegations that staff left resident in a soiled diaper for an extended period of time, and staff did not shower resident in care, staff consistently stated all residents take showers every day or bed baths for non-ambulatory residents and that staff perform diaper checks throughout the day and at night. When residents have bandages or band-aids, staff stated they either use waterproof bandages during showers or remove the bandage prior to bathing and replace it with a new one afterward. Review of the facility records did not corroborate the allegations. R1's diaper check-in log revealed that staff conducted routine checks throughout the day every 3-4 hours, and every 2 hours throughout the night. Additional records revealed that R1's plan of care reflects that R1 requires one person assistance for all activities of daily living including daily showers. Regarding the allegation that staff did not report resident's incident to the resident's authorized representative, Staff interviews consistently stated that on October 10, 2025, at approximately 11:00 a.m., R1, who was seated in a wheelchair, slid down onto their buttocks. Staff reported that R1 did not express any pain or discomfort following the incident. The facility notified a medical clinic and communicated with a nurse, staff, and Community Care Licensing Division (CCLD) on the same day that the incident occurred. Staff stated that the resident’s authorized representative was not informed of the incident until 10/14/2025. Staff acknowledged that the POA could have been informed earlier, however it was reported within the required timeframe. Records review of the facility's incident report from 10/10/2025 were consistent with staff statements made during interviews. Text message correspondence on 10/14/2025 between staff and R1's POA were consistent with staff statements, as staff informed R1's POA of the incident four(4) days after it occurred. Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violations occurred, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with ________ to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided and their signature on this report confirms receipt of the Licensee Rights.the state’s words, verbatim · CDSS document, Jan 16, 2026 · control 08-AS-20251020093201

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Janet Ngallo conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Administrator Travonna Washington. According to the facility’s license, the facility has a maximum capacity of six(6) residents, of whom may be non-ambulatory, and one(1) may be bedridden in bedroom #1 or #2. LPA Ngallo, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Hot water temperatures at taps accessible to residents were all compliant. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water on the premises. Per Licensee, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. (Cont. LIC 809-C) (Cont. from LIC 809) LPA interviewed staff and reviewed multiple staff and resident records/files. LPA interviews did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were stored in locked areas. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Administrator Travonna Washington to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Jan 16, 2026

Allegation investigated: Staff took away resident's personal cellphone. Staff yelled at client in care.

Licensing Program Analyst (LPA) Janet Ngallo conducted an unannounced visit to initiate a complaint investigation and deliver findings regarding the above complaint allegations. LPA introduced themselves and disclosed the purpose of the visit to Administrator Travonna Washington. It was alleged that staff took away resident's personal cellphone and staff yelled at a resident in care. CCLD’s investigation involved an unannounced facility visit, review of facility records, interviews with facility staff, residents, outside sources, and LPA direct observations. Regarding the allegations, staff, resident, and outside source interviews, as well as facility records evidenced that the alleged caregiver is not a staff member at this facility. Based on records and interviews, the allegations are unfounded, meaning it was false, could not have happened, and/or is without a reasonable basis. The allegations have therefore been dismissed. An exit interview was conducted with administrator Travonna Washington, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided. Unfoundedthe state’s words, verbatim · CDSS document, Jan 6, 2026 · control 08-AS-20251231120605

Allegation investigated: Staff is not providing adequate supervision resulting in resident sustaining multiple falls.

Licensing Program Analyst (LPA) Janet Ngallo conducted an unannounced visit to initiate a complaint investigation and deliver findings regarding the above-mentioned allegation. LPA identified themselves and met with administrator Travonna Washington, to discuss the purpose of the visit and elements of the complaint. Facility Manager Vinny Rathi later joined the visit. On 12/08/2025, it was alleged that staff is not providing adequate supervision resulting in a resident sustaining multiple falls. The Department’s investigation consisted of an unannounced facility visit, interviews with facility staff, residents, an outside source, and a review of facility records. (Cont. on LIC 9099-C) Unsubstantiated (Cont. from LIC 9099) Regarding the allegation, staff consistently stated that Resident 1 (R1), who has a diagnosis of dementia, received consistent supervision throughout the day and night. Staff reported conducting frequent checks, particularly due to R1’s inability to use the call alarm system and increased ambulation associated with a recent urinary tract infection. Staff confirmed that R1’s authorized representative and medical provider were notified following the most recent fall, and that environmental adjustments, such as removing furniture and adding fall mats, were being discussed. Resident 2 (R2) stated that R1’s bedroom door was sometimes open and sometimes closed, and reported hearing about R1’s fall from staff. R2 had not witnessed any incidents but had observed staff interacting with and assisting R1. Outside Source 1 (OS1), R1’s authorized representative, stated that the facility promptly informed them of the fall and consistently communicates regarding R1’s care. OS1 stated that they were confident that the facility was doing its best to supervise R1 and had been responsive to concerns about room safety. Records reviewed included R1’s plan of care, resident appraisal, physician’s report (LIC 602), needs and services plan, emergency room documentation, communication records, staffing schedules, and rosters. These documents consistently described R1 as ambulatory, requiring one-person assistance with ADLs, and needing structured routines and supervision due to dementia and a history of UTIs. Records confirmed timely notification to R1’s authorized representative and adequate staffing levels during the relevant time period. The LIC 602, plan of care, needs and services plan, and other reviewed records provided consistent information and corroborated the staff, resident, and outside source interviews regarding the allegation. (Cont. on LIC 9099-C pg.2) (Cont. from LIC 9099-C pg. 1) LPA observed R1 ambulating throughout the facility and noted visible bruising and minor facial injuries. R1 demonstrated signs of confusion during the interaction. LPA observed R1’s bedroom, which contained multiple furniture items, including a large China cabinet. LPA advised the facility manager to consider fall risk mats in R1’s room. Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violations occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Administrator Travonna Washington, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided and their signature on this report confirms receipt of the Licensee Rights.the state’s words, verbatim · CDSS document, Dec 11, 2025 · control 08-AS-20251208155229

Allegation investigated: Staff are allowing a child to care for residents in care.

Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to initiate an investigation on the above-mentioned allegations. LPA identified herself and discussed the purpose of the visit with Guarav “Gary” Rathi, Co-Administrator. On June 20, 2024, Community Care Licensing (CCL) received a complaint alleging staff are allowing a child to care for residents in care. During the investigation, LPA Domingo collected pertinent resident records as well as facility documentation and conducted interviews with residents and staff. Continued on LIC9099C Unsubstantiated Continued from LIC9099 According to allegation, the staff are allowing a child to care for residents in care. According to staff interviews, the staff do not allow a child to care for the residents in care. Staff have stated that there are volunteers of different age groups that provide activities such as puzzles, art projects, entertainment and visits with the residents. Interview with residents' revealed that there is a younger person that visits with the residents and helps them with puzzles, they listen to music and watch tv. There are other visitors that provide entertainment such as singing and dancing during the holiday season. The residents stated that there has not been any child rendering care or assisting the caregivers with care giving needs for the residents. Two of the residents need adult caregivers due to the inability of the resident to assist with turning from side to side. Interviews with outside sources also confirmed that there is younger person that lives with the caregiver at the facility but the younger person was not seen rendering care to any of the residents. The outside sources confirmed that the younger person has been seen reading books, watching tv, and playing games/puzzles with the residents. Based on LPA's interviews, observations and record reviews there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegation is unsubstantiated. An exit interview was conducted with Guarav “Gary” Rathi, Co-Administrator. to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.the state’s words, verbatim · CDSS document, Dec 4, 2024 · control 08-AS-20240620145410

Allegation investigated: Staff do not ensure that residents are accorded privacy while in care.

Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to initiate an investigation on the above-mentioned allegations. LPA identified herself and discussed the purpose of the visit with Guarav “Gary” Rathi Co-Administrator. On October 11, 2024 Community Care Licensing (CCL) received a complaint alleging Staff do not ensure that residents are accorded privacy while in care.. During the investigation, LPA Domingo collected pertinent resident records as well as facility documentation and conducted interviews with residents and staff. (Continued on LIC9099) Unsubstantiated Continued from LIC9099 According to allegation, the staff are videotaping residents while the resident is in the bathroom. According to staff interviews, the staff do not videotape the resident while the resident is in the bathroom. The staff state that there are no camera's in the private areas of the facility which are the bathrooms and the resident's bedrooms. The staff at the end of each shift will take a photograph of the areas that have been cleaned for the next shift. The area's would include the kitchen, the laundry room, the bathrooms, the living room and the common areas. Interview with residents' revealed that all the staff allow the residents to have privacy while in the bathroom and in the resident's room. The residents have not observed the staff videotaping or taking pictures of the residents at any time. The residents have stated that they do not feel that their privacy has been intruded upon at any time during their stay at the facility. Interviews with outside sources also confirmed that they have not observed any staff taking pictures or videotaping of any residents while they were visiting. The outside sources stated that their family members have not verbalized any concerns about their privacy being intruded upon. LPA observed no audio cameras within the interior of the facility, that are only in the common areas. There is also and no audio camera outside of the facility to see who is outside of the door for mail. The administrator did verify that the staff are required to take a photo of the areas that have been cleaned prior to leaving at the end of their shift to provide the next shift of what areas were thoroughly cleaned. When staff are taking pictures of the bathrooms once they are cleaned can seem misleading to someone who is not a frequent visitor. Based on LPA's interviews, observations and record reviews there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegation is unsubstantiated. An exit interview was conducted with Guarav "Gary" Rathi, co administrator to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.the state’s words, verbatim · CDSS document, Dec 4, 2024 · control 08-AS-20241011154015

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Hugo Duran. LPA then met with Co-Administrator Guarav “Gary” Rathi, who arrived later during the visit. Today's visit was in response to an LIC624 Incident Report and an LIC624A Death Report, both concerning Resident #1 (R1), which Licensee self-submitted to the CCLD San Diego Regional Office (they were received on 02/27/2024 and 03/08/2024, respectively). [See LIC 811 Confidential Names List for a description of R1.] Per the reports: On 02/24/2024, Licensee’s staff arranged for R1 to be taken to a local emergency room due to change in their condition. R1 was admitted to the hospital. Then on 03/06/2024, R1 passed away at the hospital. During today’s visit, LPA performed a brief facility tour and welfare check on the remaining residents, finding no safety concerns. LPA also collected copies of and reviewed pertinent records and interviewed relevant staff. No deficiencies were observed or cited during today’s visit. An exit interview was conducted with Rathi, to whom a copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Mar 8, 2024

Type of visit: Required - 1 Year

On 1/30/2024, at about 10:05 AM, Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced Required Annual Inspection. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Travonna Washington, Co-Administrator. Gaurav Rathi, Administrator, later joined LPA for the inspection. According to the facility’s license, the age range is 60 and over; approved for capacity of six (6) non-ambulatory residents; of which one (1) may be bedridden; approved for hospice waiver for three (3) residents. On the day of the inspection four of six residents were ambulatory. During the inspection, LPA toured the interior and exterior of the facility and observed each resident’s room. The facility was organized, kempt and in good repair. Pathways inside the property were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. There was at least two days of perishable food, and at least seven days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water were observed on the premises. Per Administrator, Rathi, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. Hot water temperatures measured in the resident restroom and kitchen recorded at 111.1 and 112.7, degrees Fahrenheit which are both within Title 22 Regulations. LPA interviewed residents and reviewed staff and resident records/files. LPA interviews did not raise any licensing concerns. The files which LPA reviewed contained the required documents. LPA reviewed the facility's Infection Control Plan and did not note any concerns. Confidential records were stored in locked areas. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Administrator, Rathi to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Jan 30, 2024

Allegation investigated: Licensee did not issue resident's authorized representative a refund

On 12/15/2023, at about 8:20 AM, Licensing Program Analyst (LPA) Daniel Pena, conducted an unannounced visit to the facility to conclude a complaint investigation. LPA Pena was greeted at the entrance by Caregiver, Hugo Duran, and after identifying himself and explaining the purpose of the visit, was allowed inside the facility. Licensee, Gaurav Rathi, later arrived and LPA discussed with him the findings of the investigation. On 11/17/2023, the Department received this complaint which alleged the licensee did not issue Resident 1’s (R1) authorized representative a refund. The Department’s investigation consisted of review of facility, resident and outside source records, physical plant inspection, and interviews with facility staff and outside sources. Investigation revealed that R1 was admitted to the facility on June 29, 2023, and moved out on July 5, 2023. Interviews indicated that prior to their move in; R1 underwent a surgery. Subsequent to R1’s move Unsubstantiated in; complications with the surgery site occurred and required R1 to be transported to the hospital. Facility staff arranged for R1 to be transported to the hospital. At the hospital, R1 was diagnosed with infection to the surgery site. Interviews indicated that R1 required antibiotic administration and closer monitoring of the wound. Interviews revealed that R1 did not return to the facility. Records show that on July 10, 2023, R1’s authorized representative submitted to the licensee a 30-day notice informing them that R1 was discharging from the facility. Records showed that on July 12, 2023, R1’s personal items were removed from the facility. Admittedly, when interviewed, the licensee stated that they did not initially refund R1’s paid rent. A review of R1's admission agreement was conducted. The agreement was signed by facility staff and an authorized representative for R1 on June 29, 2023. According to the Conditions for Preadmission Fee Refund (2)(b) section of the admission agreement, “If the resident leaves the facility for any reason during the first month of residency, the resident shall be entitled to a refund of at least 80 percent of the preadmission fee amount in excess of five hundred dollars ($800).” Interviews and records confirmed that the licensee applied a credit for the preadmission fees towards remaining rent and transportation costs. The refund for preadmission fees was stipulated and clearly documented in the admission agreement. It should be noted that specific language was not present in the admission agreement, outlining the conditions for refund of pre-paid rent upon relocation of a resident. However, it should also be noted that the facility refunded a portion of R1’s monthly rental fees on 12/15/2023. Based on interviews and review of documentation, insufficient evidence was obtained to prove the licensee violated Title 22 Regulations related to the refund of preadmission appraisal fees. The preponderance of evidence standard was not met. Therefore, this allegation is Unsubstantiated which means there is not enough evidence to prove or disprove the allegation occurred as reported. An exit interview was held, and a copy of this report was discussed with Licensee, Rathi. A copy of the report along with appeal rights (01/2016) were provided to Mr. Rathi at the conclusion of the visit. Mr. Rathi’s signature on this form acknowledges receipt of these rights.the state’s words, verbatim · CDSS document, Dec 15, 2023 · control 08-AS-20231117104603