Raksha 4 Care Home

On 8/19/2025 at 10:30 AM, the Oakland CCLD Adult & Senior Care Regional Office conducted a virtual meeting with representatives for Raksha 4 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 07/08/25 around 03:15 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a case management. LPA was greeted by Co-Administraton (ADM) Sheeva Bhutani. The facility’s fire clearance was approved for six (6) non-ambulatory residents; hospice waivers for three (3). LPA and ADM reviewed the records for five (5) residents that included the most recent LIC602s. LPA confirmed that the facility sketch is current and two (2) residents are bedridden that reside in Room #1 and Room #2. This information will be forwarded to the local fire inspector for review and advisory. Exit interview conducted and a copy of this report provided to Sheeva Bhutani, Co-Administrator (ADM)

On 06/19/25 around 10:45 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a required Annual Inspection. LPA was greeted by a and Co-Administrator Shalini Bhutani (ADM) arrived about 10 minute later. The facility’s fire clearance was approved for six (6) non-ambulatory residents; hospice waivers for three (3). Upon entry LPA observed two residents having lunch. LPA reviewed the resident and staff files and Emergency Disaster Plan (EDP). LPA observed a visitor sign-in log at the entry. LPA and ADM toured the facility, including but not limited to bedrooms, bathroom, kitchen, laundry room, common area, front yard and backyard. The facility consists of four (4) total bedrooms. All indoor passageways were free of obstruction. There aren't any bodies of water. A comfortable temperature for residents was maintained at 74 degrees Fahrenheit (F), and the water temperature measured at 114.5 for the comfort and safety of all the residents. The bathroom was safe, sanitary and in operating condition. Hand washing posters, paper towels, and soap observed at 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 03/06/25, first aid kit complete and next emergency disaster drill to be conducted for the next quarter. The following forms are to be updated and submitted to CCLD on or before 06/27/25: - LIC 610D Emergency Disaster Plan (Reviewed) - Facility sketch (Reviewed) - LIC 200 (Reviewed) - Liability Insurance - LIC500 Personnel Report - LIC308 Designation of Administrative Responsibility - An updated copy of Administrator Certificate(s) Exit interview conducted and a copy of this report provided to Sheeva Bhutani, Co-Administrator (ADM)

On 03/29/2022 at 6:09 PM, Licensing Program Analyst (LPA) L. Holmes conducted an unannounced Health & Safety inspection. LPA met with Administrator, Shalini Bhutani. LPA toured facility including but not limited to the bedrooms, bathrooms, common area, kitchen, medication closet, and outdoor area. Hot water temperature was measured at 108.4 degrees Fahrenheit in the bathroom and the common area thermostat was measured at 72 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 closet. 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 06/05/23 at 02:36 PM, Licensing Program Analyst (LPA) L. Holmes arrived announced to conduct a required Annual Inspection. LPA was greeted by Care Staff and Nalini Bhutani, Administrator (ADM) upon entry and explained the purpose of the visit. The Standard Certificate (#6011402740) expires 06/20/23. The facility’s fire clearance was approved for six (6) non-ambulatory residents; hospice waivers for three (3). There is a contracted alarm company on record. 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, bathroom, kitchen, laundry room, common area, front yard and backyard. The facility consists of four (4) total bedrooms. All indoor passageways were free of obstruction. 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 117.2 for the comfort and safety of all the residents. The bathroom was safe, sanitary and in operating condition. Hand washing posters, paper towels, and soap observed at 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 06/23/2022 at 02:00 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct an Infection Control Inspection, LPA was greeted by one Caregiver upon entry and explained the purpose of the visit. The Administrator, Nalini Bhutani (ADM) was telephoned by the Caregiver and arrived about 30 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, sanitizer, and a visitor sign-in log. Advised to have masks available if needed. LPA toured the facility including, but not limited to common areas, bathrooms, bedrooms, and kitchen. LPA observed cough etiquette and hand washing signs posted. There was a sufficient supply of 2-day perishables and 7-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 including bathroom, add 20 seconds to handwashing signs, remove towel in shared bathroom, create an isolation cart and maintain a 30 day supply off PPE on site. Hot water temperature in the shared residents' bathroom was measured at 111.9 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 (Reviewed) -LIC308 Designation of Administrative Responsibility (Reviewed) -LIC610E Emergency Disaster Plan (Reviewed) -An updated copy of Administrator Certificate(s) (Reviewed) Exit interview conducted and a copy of this report provided.