American Sikh Care Facility

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection. LPA met with the Administrator to explained the purpose of the visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards. LPA observed sufficient furniture and lighting throughout the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 120 degrees Fahrenheit in staff bathroom sink, which is within the required range of 105 to 120 degrees. Fire extinguishers and smoke detectors are operational. LPA observed centrally stored medications are kept locked and inaccessible to residents. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed 3 resident's file, LPA reviewed 2 staff files, including criminal record clearances. First aid kit was checked and is complete. LPA observed carbon monoxide detectors in the facility. Per the Title 22, Division 6 of California Code of Regulations. No deficiencies were observed during today's inspection. Advisories given. Exit interview conducted and appeal rights giventhe state’s words, verbatim · CDSS document, Sep 15, 2026

Allegation investigated: Staff are not providing adequate care to residents while in care.

Licensing Program Analyst, LPA, Noel Wolf Petersen arrived unannounced to the facility on 2/3/2025 at 1:45pm to conduct a complaint investigation. LPA met with administrator Jasvir Sohi and explained the purpose of the visit. A record review of the staff files indicate that there are 2 backround checks for those residing in the facility over the age of 18 (4 adults working and or residing in the facility). Per the administrator interview, the new employee started without a backround check some 10 days ago, and her husband and thirteen year old offspring sleep in the facility over the weekend. LPA gave guidance to get the staff and her husband backround checked immediately, and they cannot work, reside, or volenteer until its finished. Administrator provided that as part of the CNA training, they have fingerprints on file with the CNA training and the husband security licence. LPA read the regulation for ccl 80012(e)(2,3,4). 916-263-4700 Office should recive the request for transfer with the california drivers license and livescan in the morning sent to, cclascpsacramentosouthro@dss.ca.gov and noel.wolfpetersen@dss.ca.gov Continued on c page. Substantiated LPA interviewed 1 clients and 2 staff. 1 client has visitors at the time of the LPA's visit, another 2 clients were taking naps. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, is being cited on the attached LIC 9099D. Citation was issued, appeal rights provided. a copy of the report was read and given to the administrator. LPA interviewed 2clients and 2 staff. 1 client has visitors at the time of the LPA's visit, another 1 client were taking naps. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. A copy of the report was read and given to staff, a copy of the appeal rights was provided. and exit interview was conducted.the state’s words, verbatim · CDSS document, Feb 3, 2026 · control 27-AS-20260129165908

From the deficiency page — Deficiency type: Type A · Section cited: CCR 80019(e)(2,3,4) · Plan of correction due date: Feb 4, 2026

80019 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department or (3) Request a transfer of a criminal record clearance as specified in Section 80019(f) or (4) Request and be approved for a transfer of a criminal record exemption, as specified in Section 80019.1(r), unless, upon request for the transfer, the Department permits the individual to be employed, reside or be present at the facility. This requirement was not met as evidenced by: administrator interview and record review where the fingerprinting for the facility was not complete for 2( one resident and one staff). This presents an immediate risk to health saftey and personal rights of the persons in care.the state’s words, verbatim · CDSS document, Feb 3, 2026

Plan of correction: The persons will be finger printed before they work or reside in the facility again. A confirmation of the finger prints cleared by the department will be sent to the LPA. noel.wolfpetersen@dss.ca.gov

Type of visit: Post Licensing

Licensing Program Analyst, LPA, Noel Wolf Petersen arrived unannounced to the facility on 2/3/2025 at 1:45pm to conduct a post licensing visit. LPA met with administrator Jasvir Sohi and explained the purpose of the visit. The facility has 4 clients, no clients with restricted care, and a total capacity of 6 clients. LPA reviewed Staff Records, including but not limited to the backround checks for DOJ,FBI, No backround Check for the employee or her husband. Citations applied as part of a complaint for this date. First aid certificate, CNA training, exists. TB screening, health eligibility is not complete. LPA Gave guidance to complete the staff file as outlined in regulation, and sent the regulation via email. LPA reviewed Client Records, including but not limited to needs and services, signed admission agreements, property and valules, recent medical assesments, and Preappriasal. one client has wandering, two clients has non insulin dependant diabeties, one client has insulin dependant diabetes. Per the administrator the insulin dependant diabetes is getting an amended 602, where a restricted exemption waiver will not be necessary. LPA is requesting an update be sent to the LPA as to the outcome of that 602 appointment. LPA reviewed the admission agreement and house rules, including mail policy, and starting and continuing Training for the staff. the Content of the annual training should be stored with the Plan of Op, and should include the 12 hours of general topics of care as described in regulation, 8 hours of dementia care, and the LPA is recommending that some time be spent training in diabetic related topics. Initial training content should also be kept with the plan of op, and include a review of personal rights, evacuation plan, and the mandatory reporting requrements. No citations were issued. A copy of the report was read and given to staff, an exit interview was conducted.the state’s words, verbatim · CDSS document, Feb 3, 2026

Type of visit: Prelicensing

at 12:45 on 9/15/25 Licensing Program Analyst, LPA, Noel Wolf Petersen arrived unannouced, to cond uct a prelicensing inspection. The LPA met with the Jasper Singh Sohi, the administrator/licensee to explain the purpose of the visit. Armerican sikh care facility, is seeking licensure as a 6-capacity RCFE, 1 bedridden, 2 nonam, 3 ambulatory. Dementia and hospice care restrictions are expected. The Physical Plant inspection included but was not limited to, bedrooms, bathrooms, common areas, kitchen, storage areas, exteriors and evacuation routes. The facility is clean, the hallways are well lit and unobstructed. Kitchen has lockable storage for knives, toxics, medications. The facility will need more adequate food supply than what was observed for clients in care. the bedrooms have required furniture and furnishings, LPA offered guidance for encasements, Facility was receptive. bathrooms, have functional hardware and deliver water temperature within the required range. common areas and exteriors have space for activities, no tripping hazzards. evacuation route gate swings freely and latches by itself. The fire extinguisher is dated 3/7/25. The required posters are present execpting the federal work rights poster, administrator mentioned it would be ordered. first aid kit has all the required items except thermometer, administrator provided it would be ordered. No staff or client interviews, no staff or client file review. Administrator documents including but not limited to, control of the property, secretary of state, facility sketch, evacuation plan, infection control plan, the program design( theft and loss policy, menus, activity callenders, house rules, refund policy) were reviewed and up to date and present. licensee will send a copy of thier completed addmission agreement, Comp 3 was given. Facility is ready for licensure. an Exit interview was conducted. a copy of the report was read and given to the administrator.the state’s words, verbatim · CDSS document, Sep 15, 2025