Raksha 6

On 08/08/25 at 1:30 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 and ADM discussed the details of the fire watch for the addition of a staff room, 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; to date the documentation has not been received. 1. Written plan designating one specific staff to perform fire watch around the clock. 2. The names of the staff assigned to such duty. One person or more for each shift, not one person covering the 24-hour shift. 3. The individual designated will perform only fire watch/walk the perimeter looking for fire/fire hazards. The plan should be clear that the fire watch staff on-duty is strictly performing fire watch only NOT in addition to caregiving. 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.

On 05/06/25 around 01:15 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a required Annual Inspection. LPA was greeted by Nalini Bhutani, Co-Administrator (ADM). The facility’s fire clearance was approved for six (6) non-ambulatory residents; hospice waivers for two (42). LPA requested the resident roster, staff roster, three (3) staff files, three (3) 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, bathroom, kitchen, common area, front yard and backyard. All indoor passageways were free of obstruction. There were not any bodies of water present. Residents were dining for lunch, and watching television. A comfortable temperature for residents was maintained at 72 degrees Fahrenheit (F), and the water temperature measured at 117.8 F. 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, auto air dryer, 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 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: -Designation of Administrative Responsibility -Case Management inspection TBD to view detached Staff Room; key is not available during visit. Exit interview conducted and a copy of this report provided to Nalini Bhutani, Co-Administrator.

On 05/29/2024 around 07:45 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a required Annual Inspection. LPA was greeted by Aesha Ahmed, Caregiver (S1) and upon entry and explained the purpose of the visit. The Co-Administrator's Standard Certificate (#6011402740) expires 06/20/25. The facility’s fire clearance was approved for six (6) non-ambulatory residents; hospice waivers for two (2). Shalini Bhutani, Administrator (ADM), arrived about 09:45 AM to sign the report. LPA observed four (4) clients having breakfast and two (2) in their bedrooms, LPA and S1 reviewed the Emergency Disaster Plan, and resident and staff files. LPA observed a visitor sign-in log at the entry. LPA and S1 toured the facility, including but not limited to bedrooms, bathrooms, kitchen, laundry area, common area, front and side yard. The facility consists of five (5) total bedrooms. All indoor passageways were free of obstruction. There weren't any bodies of water. The temperature for the residents was maintained at 79 degrees Fahrenheit (F) and the shared bathroom's water temperature was 107.8 F 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 hand washing stations. Linen and hygiene supplies were available for all residents. PPE and paper goods remain sufficient. There was 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 extinguishers last serviced on 01/22/24, first aid kit observed complete and fire drill was last conducted on 04/012/24. Four (4) staff files reviewed all had criminal record clearance. Four (4) resident files reviewed were complete. The following forms are to be updated: -LIC500 Personnel Report -LIC308 Designation of Administrative Responsibility -LIC610 Emergency Disaster Plan to be updated Exit interview conducted and a copy of this report provided to ADM.

On 06/07/23 at 09:40 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a required Annual Inspection. LPA was greeted by Nalini Bhutani, Administrator (ADM) upon entry and explained the purpose of the visit. The Administrator's Standard Certificate (#6011402740) expires 06/20/23. The facility’s fire clearance was approved for six (6) non-ambulatory residents; hospice waivers for two (2). The facility has an Infection Control Plan (ICP) on file. LPA reviewed the Emergency Disaster Plan, resident roster, resident and staff files. LPA observed a visitor sign-in log at the entry. LPA and ADM toured the facility, including but not limited to bedrooms, bathrooms, kitchen, laundry area, common area, front and side yard. Two (2) residents were watching television in the living room upon arrival. The facility consists of five (5) total bedrooms. All indoor passageways were free of obstruction. There weren't any bodies of water. The temperature for the residents was maintained at 75 degrees Fahrenheit (F) 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 hand washing stations. Add covered garbage cans to shared areas and paper towel dispenser/holders to wash 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 extinguishers 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. 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 11:37 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct an Infection Control Inspection, LPA was greeted by the Administrator, Nalini Bhutani (ADM). The facility does not have any residents at this time. Facility has a COVID-19 mitigation plan on file. LPA requested a staff and resident roster from ADM once residency begins. LPA observed screening station at the entry with hand sanitizer. ADM has painted and completed some upgrades to the floors, kitchen and bathrooms. ADM will create an isolation cart and maintain a 30-day supply of PPE. LPA toured the facility including, but not limited to common areas, bathrooms, bedrooms, kitchen, and patio. ADM to post COVID-19, cough etiquette, masks, social distancing and hand washing signs throughout. There is a locked cabinet for medication, locked drawer for sharps and locked closet for disinfectants. Hand washing stations and bathrooms are to be equipped with soap, paper towels, and covered garbage cans. Hot water temperature in the shared residents' bathroom was measured at 117.2 degrees Fahrenheit (F). Fire extinguisher last inspected 01/04/2022. Smoke/Carbon Monoxide detectors were observed operational. The following forms are to be updated and submitted to CCLD -LIC500 Personnel Report -LIC308 Designation of Administrative Responsibility -LIC610E Emergency Disaster Plan -An updated copy of Administrator Certificate(s) Exit interview conducted and a copy of this report provided.