Raksha 4 Care Home

Type of visit: Required - 1 Year

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... ...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.the state’s words, verbatim · CDSS document, Jun 5, 2023

Allegation investigated: Questionable death 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

On 02/02/23 at 10:00 AM, Licensing Program Analyst (LPA) L. Holmes conducted an unannounced visit to deliver the findings for the above allegations. LPA explained the purpose of the visit and met with Nalini Bhutani, Administrator. Allegation: Questionable death Investigation Finding: UNSUBSTANTIATED LPA confirmed with Staff #1 (S1) that a total of 11 deaths occurred at the facility from the year 2018 to 2023. LPA reviewed six (6) of eleven (11) Death Reports and one (1) Unusual Incident Report (UIR) for low blood pressure dated 12/27/18. Five (5) Residents passed away due to natural causes, terminal transitioning, cerebrovascular disease, renal disease, and Alzheimer’s; all residents received hospice services. One (1) Resident went for routine blood transfusion on 12/19/22; passed away at Oakland -Kaiser Permanente. Continued on LIC9099C… Unsubstantiated …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) of seven (7) Staff (S1, S2, S5, S7), and confirmed they did not observe any bruising or pressure injuries on Residents (R1, R2, R4, R5) while in care at the facility. R3’s Physician’s Report dated 05/14/21 documented a history of skin condition – breakdown. R3 was admitted to the facility 02/18/2018, updated the admission agreement on 09/20/21 and still resides at the facility. Per S1, R3 has a rash condition which cream is prescribed and applied. On 03/29/22, LPA observed two (2) Residents in the dining room eating dinner, S7 was preparing food for the Residents. S2 stated that S7 who was preparing food liked to cook and was also a good baker. 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 ground meat, chopped lettuce, onions, tomatoes, juice and water. Interview with W1, W1 stated that R1’s meals are fine and R1 receives ensure as a supplement. Physician’s Report dated 02/19/22 notes R1 is able to feed himself/herself and was admitted to the facility while on Hospice 10/16/21 An Interview with Witness #1 (W1) and record reviews revealed that R1 is non-ambulatory (paralysis), diagnosed with Dementia, and currently has a toe fungal infection with a 6-week medication regimen. W1 states the medication is being applied as prescribed, R1 does not like to be in bed all day, the facility assists with R1’s wheelchair and there aren’t any pressure sores. R2 and R4 do not have any mobile impairments at this time. continued on LIC 9099C... ...continued from LIC 9099C Pest Control inspections, records and receipts revealed that the facility has had a proactive treatment plan in place with Terminix sincm 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. ...continued fron LIC 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 reports did not have any 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.the state’s words, verbatim · CDSS document, Feb 2, 2023 · control 15-AS-20220328170059

Type of visit: Required - 1 Year

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.the state’s words, verbatim · CDSS document, Jun 23, 2022

Type of visit: Case Management - Health Checks

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.the state’s words, verbatim · CDSS document, Mar 29, 2022