Golden Luxe Residences - Oakley

Type of visit: Annual/Random

On 09/08/2026 at 11:30am, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced required annual inspection. LPA met with Angelina Teresi, Caregiver, and explained the purpose of the visit. Sara Bughio, Administrator was at the facility upon LPA’s arrival. LPA explained the purpose of visit. The Administrator currently holds a certificate (#6076347740) that expires on 01/09/2027. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of six (6) bedrooms and three (3) bathrooms. All outdoor and indoor passageways are kept free of obstruction. No bodies of water observed. A comfortable temperature is maintained at 75 degrees F. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 119.1 degrees F. Residents’ bathrooms are equipped with grab bars and non-skid mats. Smoke detectors/ carbon monoxide were in operating condition during visit. Fire extinguisher was last purchased on 03/17/2026. Emergency Disaster Plan was last reviewed on 08/28/2026. First aid kit was observed to be complete. Fire drill was last conducted on 08/28/2026. Continued on LIC809. Continued from LIC809. LPA reviewed five (5) staff records, and all were current and complete. All four (4) resident records were reviewed and complete. LPA also reviewed residents medications. LPA requested the following documents to be submitted to CCLD by 09/15/2026. LIC 308 Designation of Administrative Responsibility LIC 610E Emergency Disaster Plan (9 pages) Liability Insurance LIC500 (Personnel Report) LPA observed the following deficiency: At 11:30am, LPA observed the facility has a door stops or hold open device on door between living/kitchen and foyer. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (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. A copy of the appeal rights and this report provided.the state’s words, verbatim · CDSS document, Sep 8, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87203 · Plan of correction due date: Sep 9, 2026

87203 Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with section above by having a device to hold the door open between the living/kitchen and foyer which poses as a safety risk to the persons in care.the state’s words, verbatim · CDSS document, Sep 8, 2026

Plan of correction: Administrator immediately remove the door stop device from the door between the living /kitchen and foyer.Administrator will conduct a training class with staff and send a email of participants with signatures to CCL by POC date.

Type of visit: Prelicensing

On 08/20/2025 at 1:00PM Licensing Program Analyst (LPA) T. Syess-Gibson conducted an announced pre-licensing inspection. LPA met with Sara Bughio, Administrator and Ali Soomro, Licensee. The facility has a fire clearance for six (6) non-ambulatory and a hospice waiver for three (3) residents. LPA inspected the facility inside and out including but not limited to the bedrooms, bathrooms, common living areas, kitchen, garage and back yard. The facility has a total of six (6) bedrooms, two and half (2 1/2) bathrooms. There were no bodies of water present during inspection. There is sufficient lighting around the facility. Residents’ rooms are equipped with the proper furniture, bedding, and lighting. Bathroom showers/tubs were equipped with grab bars. Passageways and hallways are free of obstruction. LPA observed locked cabinets available to store medications, sharps and toxins. Hot water temperature is measured at 114.1 degrees Fahrenheit. Fire extinguisher was last purchased on 03/08/2025. Carbon monoxide and smoke detectors are present. First-Aid kit was observed complete. Facility inspection matches the sketch that was provided. LPA observed facility had some non-perishable food supply. Licensee will purchase additional food supplies once facility is licensed. Continue on LIC809 Continued from LIC809 The licensee/administrator was reminded of the statute that requires CCL to be notified within 5 business days of admitting their first resident. This notification may be made by phone, by mail, email, or by fax. No issues were noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required. LPA Conducted COMP III on 08/20/2025. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 20, 2025

Type of visit: Case Management - Other

On 08/20/2025 at 3:20PM, Licensing Program Analyst (LPA), T. Syess-Gibson arrived to conduct an announced Case Management COMP III visit. LPA met with Ali Soomro, Licensee and Sara Bughio, Administrator and explained the purpose of the visit. LPA presented Component III power point during visit and discussed the regulations embodied in the power point. LPA observed the participants gained knowledge about running and maintaining the facility in accordance with regulations. A license has not yet been granted to this facility. Licensure is subject to final review and approval by the Centralized Applications Unit. Licensee is not to accept consumers until notified by Community Care Licensing that the license has been approved. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 20, 2025

Type of visit: Office

Component II completion: Successful Facility Type: Residential Care Facility for the Elderly (RCFE) Application Type: Initial Capacity: 6 Census (if any clients in care): none COMP II Participants: Sara Bughio, Applicant/Administrator Ali Soomro, Applicant Interview Method: Virtual interview (Microsoft Teams) On August 6, 2025, Applicants/Administrator participated in COMP II. Identification of the Applicant/Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Applicants and Administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicants and Administrator’s understanding of following areas: 1. Facility Operation: License Type, Client/Resident Populations, and Program. 2. Admission Policies 3. Staffing Requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General Provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing Readinessthe state’s words, verbatim · CDSS document, Aug 6, 2025