Supra Homes

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Carol Fowler conducted an unannounced 1-year required visit on 9/29/2026 at 1:20PM. LPA met with Administrator, Sujan Gautam. The Administrator currently holds a certificate (#7021173740) that expires on 12/05/2027. The facility’s fire clearance was approved for 6 residents, 4 non-ambulatory and 2 ambulatory. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms which 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Hot water temperature in the shared residents’ bathroom was measured at 105 degree Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available for residents. There is a minimum of 7-day non-perishables and 2-day perishables foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 09/24/2026. Emergency Disaster Plan was last posted on 07/20/2026. First aid kit was observed to be complete. Report continues on 809C. Continue from LIC809 LPA reviewed staff record all staff have criminal record clearance or a criminal record exemption and staff holds a current first aid/CPR/AED certificate. LPA reviewed 1 resident' files which is complete. The following forms to be updated and submitted to CCL by 10/8/2026: LIC 500 Personnel Report LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 610E Emergency Disaster Plan Copy of Administrator Certificate Exit interview conducted, and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 29, 2026

Allegation investigated: Staff do not provide daily activities for residents in care Resident is socially isolated by staff

On 07/29/2025 at 10:15am, Licensing Program Analyst (LPA), Carol Fowler arrived unannounced to deliver complaint findings for the allegations above. LPA met with Purna Gurung, Caregiver and explained the reason for the visit. Sujan Gautam, Administrator arrived at 10:45am. During the course of the investigation, the Department toured the facility, conducted interviews with Witness 1 (W1), Staff 1 (S1) , Staff 2 (S2), Staff 3 (S3) and Resident 1 (R1), Resident 2 (R2) and Resident 3 (R3), LPA reviewed and received a copy of staff and facility roster, physicians reports for R1, R2 and R3, admission agreements, Appraisal needs and service plans, and resident appraisals. CONTINUE ON LIC9099C Unsubstantiated CONTINUE FROM LIC9099 Allegation: Staff do not provide daily activities for residents in care Investigation Finding: unsubstantiated. During the investigation LPA interviewed W1, R1, R2, R3 and S1, S2 and S3. During interviews with W1 revealed that W1 is concerned about R1s emotional distress when R1 expressed problems with IRS and the feeling of loneliness. Tour and Interview with S1 revealed that the facility has activities that the LPA observed. S1 stated that the facility offers activities to residents and the residents often refused to participate, S1 stated that R1 will come from R1s room and watch TV, play cards with staff and talk and go out on the deck for sunshine and has exercised and had played games with S1 child. Interview with S2 revealed that the facility has activities such as board games and outside games like ping pong, S2 stated that there is only one resident R1 that will come out of the room to play cards, watch TV and sometime will go outside to watch the ping pong game. S2 stated that R1 will watch TV with staff especially the news and R1 will eat with the staff. S3 stated that the facility has activities such as cards, play ball games, watch TV together and R1 likes to watch the news S3 stated that the staff will watch the TV in their language when no residents are in the living room and there is one resident R1 that likes to watch some of the shows S3 stated that when the residents come in staff will give the remote to the resident or ask what the resident would like to watch.. S3 stated that R1 will ask if the staff is busy and would ask to talk with the staff. Interview with R1 revealed that R1 would like to move back to R1s home and R1 had a couple of friends at the facility that ended up on hospice and passed. R1 stated that R1 has tried to go to the bedroom doors of current residents but they don’t want to talk. R1 also stated that R1 is feeling lonely since R1 had two residents that was R1 friends, and they passed. R1 stated that R1 plays cards with staff and like to watch staff movies in their language because R1 might learn something new. R1 stated that the facility offered painting with easels and paints and R1 was interested but didn’t express interest in it because R1 was not in a good head space. R1 stated that R1 plays cards, watch TV and talks with staff but there’s a language barrier so they are not able to keep the conversation going. CONTINUE ON LIC9099C CONTINUE FROM LIC9099C R1 stated that the families of the friends R1 had at the facility are no longer visiting the facility. R1 now has no interaction with the family of the friends that passed at the facility. R1’s mother is in a wheelchair and sister is living in New York, so they are not able to visit R1. R1 also stated that R1 will go out on the deck and exercise and play a game with the administrator child. R1 stated that R1 is not complaining about the facility because they take good care of R1. R1 is just feeling lonely, and the facility has saved R1s life. Interview with R2 revealed that R2 has not done any exercise because it causes R2 pain. R2 stated that R2 would rather not engage in any activities and likes miniature golf when R2 would play with R2 dad when R2 was young. R2 stated that R2 enjoys staying in R2 room. Interview with R3 revealed that R3 doesn’t like living in the facility because wants to live at R3 home. R3 stated that R3 doesn’t want to participate in activities and R3 stated that the facility is nice but R3 wants to go home. R3 has been living in the facility about a week. Therefore, this allegation is UNSUBSTANTIATED Allegation: Resident is socially isolated by staff Investigation Finding: unsubstantiated. During the investigation LPA interviewed W1, S1, S2 and S3, R1, R2 and S2. Interview with W1 revealed that W1 is concerned about R1s emotional distress due to R1s loneliness. Interview with S1 stated that staff is at the facility and talks with residents and try and get the residents to engage with each other, but a couple of the residents will not participate in socializing with other residents. S1 also stated that maybe the residents get tired of being social with staff because they see them so much. S1 stated that the facility is willing to assist all the residents in whatever the resident’s needs. Interview with R1 revealed that R1 has conversations with staff but feels the language barrier prevents staff from keeping the conversation going R1 also stated that R1 likes to watch TV with staff. Interview with R2 revealed that R2 would rather stay in R2 bedroom and will talk with staff and residents but does not enjoy it. Interview with R3 revealed that R3 wants to go home and does not want to participate. Interview with S2 revealed that staff talks with the residents and eats together. Interview with S3 revealed that staff talks with residents and watch movies together. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 29, 2025 · control 15-AS-20250721101059

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Carol Fowler conducted an unannounced 1-year required visit on 7/22/2025 at 2:15PM. LPA met with Administrator, Sujan Gautam. The Administrator currently holds a certificate (#7021173740) that expires on 12/05/2027. The facility’s fire clearance was approved for 6 residents, 4 non-ambulatory and 2 ambulatory. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms which 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Hot water temperature in the shared residents’ bathroom was measured at 105 degree Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available for residents. There is a minimum of 7-day non-perishables and 2-day perishables foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 9/07/2024. Emergency Disaster Plan was last posted on 07/22/2025. First aid kit was observed to be complete. Report continues on 809C. Continue from LIC809 LPA reviewed staff record 3 of 4 staff have criminal record clearance or a criminal record exemption and 3 of 3 staff holds a current first aid/CPR/AED certificate. LPA reviewed 3 resident' files which are complete. The following forms to be updated and submitted to CCL by 07/30/2025: LIC 500 Personnel Report LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 610E Emergency Disaster Plan Copy of Administrator Certificate Exit interview conducted, and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 22, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Carol Fowler conducted an unannounced 1-year required visit on 7/30/2024 at 9:50am. LPA met and started tour with Caregiver, Urmila Parajuli and Pratiksha Kharel. Administrator, Sujan Gautam arrived at 10:15am and completed the tour with LPA. The Administrator currently holds a certificate (#7021173740) that expires on 12/05/2025. The facility’s fire clearance was approved for 6 clients, 4 non-ambulatory and 2 ambulatory. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms which 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Hot water temperature in the shared residents’ bathroom was measured at 105 degree Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available for residents. There is a minimum of 7-day non-perishables and 2-day perishables foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 6/13/2023. Emergency Disaster Plan was last posted on 07/30/2024. First aid kit was observed to be complete. Report continues on 809C. Continue from LIC809 LPA reviewed staff record 3 of 3 staff have criminal record clearance or a criminal record exemption and 2 of 3 staff holds a current first aid certificate. LPA reviewed 3 resident' files which are complete. The following forms to be updated and submitted to CCL by 08/06/2024: LIC 500 Personnel Report LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 610E Emergency Disaster Plan Copy of Administrator Certificate Exit interview conducted, and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 30, 2024