Raksha 13 Care Home

On 08/08/25 at 12:00 PM, LPA L. Holmes conducted a case management visit to discuss the implementation of a fire watch and a plan going forward to bring the facility into compliance. Lpa met with Nalini Bhutani, Co-Administrator. LPA and ADM discussed the details of the fire watch, required requested documents by CCLD, and the results from the fire drill conducted on 08/01/25 at Raksha 4. On 08/01/25, LPA requested the following documentation as soon as possible in addition to the Albany Fire Department requesting a strategy by close of business on 08/01/25 for Raksha 4 and Raksha 6; documentation was not received. Interviews with S1 and W1, revealed that R1 was admitted to the facility on 07/25/25, is bedridden, and the facility has not received approval from CCLD. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties . Exit interview conducted, Appeal Rights, and a copy of this report provided.

Continued from LIC9099. During the investigation the complainant stated R1 was charged additionally for basic services and therapy. LPA reviewed the admission agreement and observed the additional services in section F (Level of Care) which were also included in section B (Basic Services), except for therapy. S3 stated R1 did receive therapy from home health as well as the staff. Based on LPA’s interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED . California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. Exit interview conducted. A copy of the appeal rights and this report provided. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Continued from LIC9099. During the investigation the complainant stated R1 requested information regarding medication and R1’s financial contract to be made available to his family members and staff were not allowing an authorized representative to access R1’s records. During interview with W1, it was stated that the facility gave all information requested. LPA reviewed the durable power of attorney notarized January 26, 2023, and the advanced health care directive notarized on November 21, 2024. Both named R1’s responsible person that was able to make decisions. Allegation: Staff are unable to communicate effectively During the review of complaint submitted the complainant stated R1 reported that the staff often spoke limited English or was hard to understand which made staff unable to communicate effectively mostly at night. W1 stated during investigation there was not any problem communicating with the staff. LPA spoke with staff at the facility and did not have any problem communicating. Allegation: Staff demonstrated inappropriate form of discipline towards a resident During the review of complaint submitted the complainant stated R1 reported being punished/neglected for asking for help at night, which demonstrated staff conducting inappropriate form of discipline towards a resident. The complaint stated R1 received mental abuse. W1 stated during interview that R1 was never disciplined or Continued on LIC9099C. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Continued from LIC9099C. neglected. W1 stated the facility took care of R1 to the best of their disability. S3 stated there was no report of any type of punishment or discipline towards any of the residents. Allegation: Staff did not answer timely to the facility telephone During the review of complaint submitted the complainant stated the facility staff never answered the facility telephone and the voicemail box was always full. LPA reviewed text messages dated December 20, 2024, between the reporting party and S3 regarding R1’s phone and the facility phone. S3 stated that the staff answers the phone but there were times when the staff is busy and not able to answer or assist R1 with his phone. S3 also stated R1’s family members called and visited the facility and there weren’t any problems. Allegation: Staff mishandled a resident's medication During review of the complaint submitted the complainant stated staff continued to administer medication and the medication was increased over the five (5) month period that R1 resided at the facility. Complainant also stated there were no visits to the doctor to justify the increase. LPA reviewed the facility assessment notes, the physician’s orders, and the medication administration (MAR) records from October 2024 until March 2025. LPA observed on the MAR’s and physician reports there were notes where the medicine was changed and discontinued. LPA observed from the assessment notes indicating there were visits and a meeting from the EASE Care nurse Continued on LIC9099C. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Continued from LIC9099. for R1. S3 stated there were never any changes without the responsible party being aware. Allegation: Staff interfered with a resident's medical decisions During review of the complaint submitted the complainant stated R1 verbally expressed he did not want additional medication, but staff continued to administer the medication. LPA reviewed R1’s Advance Health Care Directive notarized November 21, 2024, which named the person responsible for R1’s medical decisions. S3 stated there were not any changes done unless the nurse makes the request and it had to be ordered by the physician. The facility staff cannot increase, decrease, or add any type of medication whether a prescription is needed or if it’s over the counter to any of the residents. Allegation: Staff did not abide to the admission agreement During review of the complaint submitted the complainant stated the facility did not abide by the admission agreement. During interviews with S1, S2, S3, and W1 it was stated that the facility did abide to the admission agreement. After reviewing the admission agreement, it was identified that the facility did abide by the admission agreement. Based upon the information obtained during investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and a copy of report was given .

On 8/19/2025 at 10:30 AM, the Oakland CCLD Adult & Senior Care Regional Office conducted a virtual meeting with representatives for Raksha 13 to review the plan of corrections for violations dated 08/08/2025. CCLD Licensing Program Manager, Yvonne Flores-Larios, discussed the fire clearance violations, plans to get back into compliance, questions, and clarifications were addressed. Meeting Participants: • Isaac Taggart– Licensing Regional Manager, CCLD, Oakland ASC • Yvonne Flores-Larios – Licensing Program Manager, CCLD, Oakland ASC • Lisha Holmes – Licensing Program Analyst, CCLD, Oakland ASC • Shalini Bhutani – Administrator, Raksha 13 • Sheeva Bhutani – Administrator, Raksha 4 • David Ridley – City of Albany Fire Inspector This report was emailed to Shalini Bhutani for signatures and to be returned to CCLD Oakland Regional Office.

On 05/06/25 around 10:15 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a required Annual Inspection. LPA was greeted by one Care Staff upon entry and explained the purpose of the visit; Nalini Bhutani, Co-Administrator (ADM) arrived about 10 minutes later. The facility’s fire clearance was approved for thirteen (13) non-ambulatory residents; hospice waivers for four (4). LPA requested the resident roster, staff roster, three (3) staff files, five (5) resident files. LPA observed a visitor sign-in log at the entry. Emergency Disaster Plan is posted. LPA and ADM toured the facility, including but not limited to bedrooms, two (2) bathrooms (BA), kitchen, common area, front yard and backyard. All indoor passageways were free of obstruction. There were not any bodies of water present. Residents were lounging and watching television, one (1) went on a walk, the others were either sleeping, or engaged in something else. A comfortable temperature for residents was maintained at 72 degrees Fahrenheit (F), and the water temperature measured at 129.6 (F) in BA #1 and 118.2 in BA #2. LPA observed lighting in all rooms to be adequate for the comfort and safety of all the residents. The bathrooms were safe, sanitary and in operating condition. Hand washing posters, paper towels, and soap observed at all hand washing stations. Linen and hygiene supplies were available for all residents. PPE and paper goods remain sufficient. There is a minimum supply of 2-day perishables and 7-days of non-perishable foods. continued on LIC809C... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 ...continued from LIC809 Smoke detectors/carbon monoxide were in operating condition during visit. Fire extinguisher last serviced on 11/22/24, first aid kit is stored in a locked medication room, and the last emergency disaster drill was conducted on 02/2024 with the fire department; next quarterly drill to include all staff and residents. The following forms are to be updated: -LIC308 Designation of Administrative Responsibility -LIC610D Emergency Disaster Plan to be updated. Exit interview conducted and a copy of this report provided to Nalini Bhutani, Co-Administrator.

Licensing Program Analyst (LPA) Delmundo conducted a health and safety inspection as a result of the Department receiving a complaint (15-AS-20211203145000). LPA met with Shalini Bhutani (administrator) and Nalini Bhutani (co-administrator) and informed the purpose of visit. LPA toured the facility inside out with Shalini Bhutani. LPA inspected the living room, kitchen, dining area, bedrooms, bathrooms, side and backyards. The medication room was observed open with the med-tech inside the room working on the medications. Cleaning supplies were kept in a lock closet. Facility has sufficient lighting. Hallways and passageways were observed free of obstructions. No deficiency cited during this visit. Exit interview conducted and copy of this report provided.

…continued from LIC9099 Allegations: Residents have developed pressure injuries while in care Residents are not being provided a sufficient quantity of food Residents are not being provided a sufficient quality of food. Residents are not being rotated while in care Facility has pests Investigation Findings: UNSUBSTANTIATED LPA interviewed four (4) Staff (S1, S2, S5, S7) of seven (7) and confirmed they did not observe any bruising or pressure injuries on Residents (R1, R2, R3, R4) while in care at the facility. R3’s Physician’s Report dated 05/14/21 documents a history of skin condition – breakdown. Per S1 and records, there weren't any physician's orders for R3's dry skin condition from date of admission 03/21/22 to discharge date of 10/23/22. Care staff would apply Aveeno lotion to obvious signs of dry skin as prevention and to aide R3's dry skin. On 03/29/22, LPA observed two (2) Residents in the dining room eating dinner; S8 was preparing the food for the residents. One (1) Resident was watching television. S2 stated that S8 was a good cook. S2 not only shopped and purchased food/goods for the facilities, but also for the Staff to take home in order to cut down on the number of trips to the store and the potential spread of COVID-19. On 01/04/23, S1 provided three (3) monthly sample menu’s that appeared to be balanced meals for breakfast, lunch, two (2) snacks, dinner and desert consisting of a variety of daily nutrients. LPA observed what appeared to be a soup/stew being served, a dinner roll, juice and coffee. Interviews with Witnesses (W1, W4) and record reviews revealed that R1 passed away 10/28/22, was diagnosed with Dementia, and that the facility aided R1 with research treatment and overseeing the donation of R1’s remains to science. W4 stated R1 is a fall risk, has had falls multiple times but is very independent. W4 feels like R4 is safe and both S1 and S2 have been a great help. W4 has been satisfied with the level of care since R4 moved into the facility in 2019. R5’s Physician’s Report dated 04/01/21 revealed R5 as having sundowning syndrome; R5 likes to sleep during the day and was noted having redness on his/her back; there were no additional orders. S1 stated that R5 likes to sleep all of the time, doesn't like to shower and shave often. R5 and R6 do not have any mobile impairments at this time, R1 was not a fall risk and health declined fairly quickly. continued on LIC9099C... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 ...continued from 9099C Pest Control inspections, records and receipts revealed that the facility has had a proactive treatment plan in place with Terminix since 10/03/17. The quarterly report for 01/11/22 targeted ants, and on 04/12/22 there were no further recommendations or concerns. Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are UNSUBSTANTIATED. No deficiencies cited, exit Interview conducted and a copy of this report provided to Administrator, Nalini Bhutani.

On 06/05/23 at 10:50 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a required Annual Inspection. LPA was greeted by Nalini Bhutani, Co-Administrator (ADM) upon entry and explained the purpose of the visit. The S tandard Certificate (#6011402740) expires 06/20/23. The facility’s fire clearance was approved for thirteen (13) non-ambulatory residents; hospice waivers for four (4). The facility has an Infection Control Plan (ICP) on file. LPA reviewed the resident roster, staff files and Emergency Disaster Plan. LPA observed a visitor sign-in log at the entry. LPA and ADM toured the facility, including but not limited to bedrooms, two (2) bathrooms (BA), kitchen, common area, front yard and backyard. The facility consists of seven (7) total bedrooms. All indoor passageways were free of obstruction. Minor construction is underway and debris will be removed upon completion. There aren't any bodies of water. A comfortable temperature for residents was maintained at 72 degrees Fahrenheit (F), and the water temperature measured at 111.7 in BA #1 and 107.2 in BA #2. LPA observed lighting in all rooms to be adequate for the comfort and safety of all the residents. BA's were safe, sanitary and in operating condition. Hand washing posters, paper towels, and soap observed at all hand washing stations. Linen and hygiene supplies were available for all residents. PPE and paper goods remain sufficient. There is a minimum supply of 2-day perishables and 7-days of non-perishable foods. continued on LIC809C... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 ...continued from LIC809 Smoke detectors/carbon monoxide were in operating condition during visit. Fire extinguisher last serviced on 01/16/23, first aid kit observed complete and fire drill was last conducted on 04/2023. Five (5) staff files reviewed all had criminal record clearance, first-aid, and CPR. Five (5) resident files reviewed were complete. The following forms are to be updated: -LIC500 Personnel Report -LIC308 Designation of Administrative Responsibility (Reviewed) -LIC610C Emergency Disaster Plan (Reviewed) and to be updated. -An updated copy of Administrator Certificate(s) Exit interview conducted and a copy of this report provided to Nalini Bhutani, Administrator.

On 05/10/2022 at 10:14 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct an Infection Control Inspection, LPA was greeted by one staff upon entry and explained the purpose of the visit. The Administrator, Nalini Bhutani (ADM) was telephoned by the staff member and arrived about 5 minutes later. Facility has a COVID-19 mitigation plan on file. LPA requested a staff and resident roster from ADM. LPA observed screening station at the entry with COVID-19 signage and a visitor sign-in log. Visitors are requested to wash hands. Sanitizer and masks are available. LPA toured the facility including, but not limited to common areas, bathrooms, bedrooms, kitchen, and backyard. LPA observed cough etiquette and hand washing signs posted. There was a sufficient supply of 7-day perishables and 2-day supply of non-perishable foods. All hand washing stations were equipped with soap and paper towels.ADM to provide covered garbage cans in shared areas. Hot water temperature in the shared residents' bathroom was measured at 105.2 degrees Fahrenheit (F) and facility temperature was 72 degrees (F). Fire extinguisher last inspected 01/04/2022 and was observed full. Smoke/Carbon Monoxide detectors were observed operational. The following forms are to be updated and submitted to CCLD -LIC500 Personnel Report (Received) -LIC308 Designation of Administrative Responsibility (Reviewed) -LIC610E Emergency Disaster Plan -An updated copy of Administrator Certificate(s) Exit interview conducted and a copy of this report provided.

On 03/29/2022 at 4:17 PM, Licensing Program Analyst (LPA) L. Holmes conducted an unannounced Health & Safety inspection. LPA met with Co-Administrator, Nalini Bhutani. LPA toured facility including but not limited to the bedrooms, bathrooms, common area, kitchen, medication room, and outdoor area. Hot water temperature was measured at 108.5 degrees Fahrenheit in the bathroom and the common area thermostat was measured at 75 degrees Fahrenheit. 7-days of non-perishables and 2-days of perishable food supplies were present. Facility orders food supplies 1-2 times a week or more. Resident's medications were kept locked in the medication room. Smoke and carbon monoxide detectors are combined and observed throughout the facility and the bedrooms,. First-aid kit was complete. Fire extinguisher was observed to be full and last inspected 01/04/2022. No accessible bodies of water were observed. Indoor and outdoor passageways were free of obstruction. Mitigation plan on file and following COVID-19 guidelines. No deficiencies are cited on this date. Exit interview conducted. A copy of this report provided.

On 12/16/2021 at 1:25PM, Licensing Program Analyst (LPA) G. Luk conducted an unannounced Health & Safety inspection. LPA met with Administrator, Nalini Bhutani. LPA toured facility including but not limited to the bedrooms, bathrooms, common area, kitchen, medication room, and outdoor area. Hot water temperature was measured at 117.1 degrees F in the kitchen sink. 7-day of non-perishable and 2-day of perishable food supplies were sufficient. Facility orders food supplies 1-2 times a week. Resident's medications were kept locked in the medication room. Smoke detectors are interconnected with the sprinkler system. Carbon monoxide detector observe. First-aid kit was complete. Fire extinguisher was observed to be full. There are no accessible bodies of water observed. Indoor and outdoor passageways are free of obstruction. Emergency disaster plan was last updated on 1/19/2021. No deficiencies are being cited on this date. Exit interview conducted. A copy of this report provided.