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We haven’t transcribed this report yet. The complete document is on the state’s site.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Pang Lee conducted an unannounced case management visit to the facility on 08/13/2026. Upon arrival, LPA Lee was met by Care Staff Janice Reid. Reid contacted Administrator Vivek Sharma, and LPA Lee conducted a brief telephone interview with Administrator Sharma. The facility’s current census is five residents. LPA Lee explained that the purpose of the case management visit was to amend a complaint LIC 9099-D page and obtain the required signature. Per the California Code of Regulations, Title 22, no deficiencies were observed or cited during today’s visit. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 13, 2026

Allegation investigated: Staff serves expired food to residents.

On 07/01/2026, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with direct care staff Gyaneshwari Verma and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the above allegations. The care staff Verma called the Designated Administrator (DA) Vivek Sharma to inform him that Community Care Licensing Division (CCLD) was present in the home. A brief interview was conducted with Administrator Sharma. The current census is six. It was alleged that staff were serving expired food to residents in care. The investigation included interviews with staff and residents, as well as direct observations. LPA Lee interviewed 2 of the 4 residents, who stated they did not like the food being served due to the taste and would like more variety of meals being offered. Interviews with facility staff revealed that 1 of the 3 staff interviewed admitted that expired food had been served to a resident in care. CONTINUED LIC 9099-C Substantiated During a visit to the facility on 06/17/2026, LPA Lee and Staff 1 (S1) inspected the facility’s seven day non-perishable food supply and observed two containers of beef stock in the pantry with an expiration date of 03/13/2026. LPA Lee and S1 also inspected the refrigerator and observed a nearly empty bottle of mustard with an expiration date of 07/07/2025. During the visit, Administrator Sharma discarded the expired items and stated they were unsure why the nearly year old mustard had remained in the refrigerator. As a result, the allegation is SUBSTANTIATED. The finding that the complaint is substantiated means that the allegation is valid because the preponderance of the standard has been met. Deficiency cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted with care staff Verma and a copy of this LIC 9099, LIC 9099-D page and appeal rights provided to the facility. During LPA Lee’s visit on 06/17/2026, LPA did not observe a posted menu inside the facility; however, upon request, the Administrator provided a sample of the facility menu. Review of the sample menu showed that it includes well balanced meals with fruits and vegetables offered for breakfast, lunch, and dinner. Based on interviews conducted with staff and a review of the facility’s sample menu, the allegation that staff are not following the food menu is unsubstantiated. Although a posted menu was not observed during the visit, the facility was able to provide a sample menu upon request, and interviews indicated that residents are served well balanced meals with appropriate variety. Therefore, there is not enough evidence to support the allegation. As a result of this investigation, LPA finds the allegation above to be UNSUBSTANTIATED. A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with care staff Verma and a copy of this LIC 9099 report was provided to the facility.the state’s words, verbatim · CDSS document, Jul 1, 2026 · control 27-AS-20251208111014

From the deficiency page — Deficiency type: Type B · Section cited: CCR 8755(b)(8) · Plan of correction due date: Jul 8, 2026

THIS IS AN AMENDED DOCUMENT 87555(b)(8) General Food Service Requirements (b) The following food service requirements shall apply: (8) All food shall be of good quality… This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above. LPA Lee observed expired food in the pantry and in the refrigerator. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 1, 2026

Plan of correction: During 06/17/2026 visit, the Administrator discarded the expired food items. The Administrator stated he will purchase labels to place canned goods in the pantry to make expiration dates more visible and will implement a system to rotate stock so that items nearing expiration are moved to the front for use. The Administrator agreed to review the regulation cited and will provide LPA Lee with a written statement of acknowledgment by the POC due date of 07/08/26, end of day 5:00 PM.

Type of visit: Collateral

On 9/19/25 at 11:15am, Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced collateral inspection to conduct an interview with a resident regarding their previous placement at a licensed facility. LPA met with Licensee Vivek Sharma. LPA met with R1 and conducted a collateral interview. No deficiencies observed or cited during today's inspection. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Sep 24, 2025

Type of visit: Post Licensing

On 9/24/2025, Licensing Program Analyst, Arvin Villanueva (LPA), arrived at this facility unannounced to conduct the post-licensing inspection visit. LPA initially met with staff on duty, Hirut Taye and stated the purpose of the visit. The administrator, Vivek Sharma, was notified and arrived shortly after. This visit was conducted concurrently with the annual visit today. Previous post-licensing visit attempt was conducted by LPA Christina Valerio on 1/2/2025. At that time, there were no residents in care. First resident was admitted on June 23rd, 2025. LPA conducted physical inspection of the facility, reviewed resident and staff records, and conducted interview with staff and residents. Post licensing is complete. Exit interview was conducted. Report was provided to licensee.the state’s words, verbatim · CDSS document, Sep 24, 2025

Type of visit: Required - 1 Year

On 9/24/2025, Licensing Program Analyst, Arvin Villanueva (LPA), arrived at this facility unannounced to conduct the annual inspection visit. LPA initially met with staff on duty, Hirut Taye and stated the purpose of the visit. The administrator, Vivek Sharma, was notified and arrived shortly after. This visit was conducted concurrently with post-licensing today. Overview: Facility is a one-story home located in a residential neighborhood. Facility is licensed to serve up to 6 elderly residents, up to 6 may be non-ambulatory, 1 can be bedridden in room #6 on the facility sketch. Facility has a hospice waiver for 2. Initial Observation: Present during this visit were 5 residents with 1 staff on duty. LPA observed required posters and facility license at the entrance. Room temperature was at 74 degrees Fahrenheit upon arrival. Physical Inspection: Areas inspected include, but not limited to, the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA inspected 3 resident bedrooms. Bedroom #6 is currently vacant. LPA measured the hot water temperature in the 1 of the bathrooms to be at 111 degrees Fahrenheit. Bathrooms were observed to be in good repair, equipped with grab bars and non-skid flooring. Fire extinguisher was observed in the living room area and was last inspected on 8/29/2025. Smoke and carbon monoxide detectors were observed throughout. LPA observed centrally stored medications, toxins, and sharp objects were kept locked and inaccessible to residents in care. In the livingroom area, LPA observed the fireplace not screened. Per licensee, they do not utilize the fireplace. LPA also observed a cane was placed at the bottom of the sliding exit door. In the kitchen area, LPA observed sufficient seven day non-perishable and two day perishable food supplies. Pantry was observed to be fully stocked with non-perishable food items. Proper storage of food items were observed. Kitchen refrigerator and freezer were maintained at regulatory temperature. Outdoor area was inspected. LPA observed a covered patio with outdoor furniture for resident use. LPA observed a table obstructing the emergency walkway on the right side of the facility. Advisory was provided to remove the table. Record Reviews: Review of 5 of 5 resident files was conducted, include review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. Advisory was provided to licensee to obtain PRN authorization for each residents in care. Medication review of 2 residents, include review of physician orders for over-the-counter medications. Facility utilizes an electronic MAR for routine and PRN medications. Review of 3 staff files, include review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. No issues were noted at this time. LPA also reviewed fire drill/disaster drill records; facility conducts quarterly drill. LPA was provided a copy of current Liability Insurance Certificate, LIC500 and updated Dementia Care Plan during this visit. The updated LIC 308 will be provided via email. Interviews: LPA interviewed 1 staff. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies were cited. Exit interview was conducted with Vivek Sharma. A copy of the report was provided upon exit.the state’s words, verbatim · CDSS document, Sep 24, 2025

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Collateral

On 9/19/25 at 11:15am, Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced collateral inspection to conduct an interview with a resident regarding their previous placement at a licensed facility. LPA met with Licensee Vivek Sharma. LPA was informed by licensee and staff member present that R1 is currently on an outing with a family member. LPA will return on a later date to conduct interview. No deficiencies observed or cited during today's inspection. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Sep 19, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Christina Valerio and Licensing Program Manager (LPM) Stephen Richardson arrived announced to conduct the Pre-Licensing Visit and complete Component III. LPA and LPM met with Licensee Vivek and Property Owner Jay Vijay, and explained the purpose of the visit. The facility has an approved fire clearance to service individuals aged 60 years and older, approved for six (6) non-ambulatory residents, of which one (1) may be bedridden and live in bedroom #4. The facility has been approved for a Hospice Waiver for two (2) residents maximum. LPA observed a discrepancy on the fire clearance vs the location of the bedridden room. LPA observed bedroom #6 to be the room intended for the bedridden resident. LPA Valerio contacted the fire inspector listed on the granted fire clearance. An updated clearance was sent to LPA Valerio's email with the correct room number. The facility is approved for one (1) bedridden resident to live in bedroom #6. LPA Valerio will submit the updated copy to Licensee and CAB analyst Morrison. LPA Valerio reviewed the facility's Emergency Disaster Plan and Infection Control Plan. The facility has a dementia care plan on file. LPA, LPM, and Licensee conducted a walk-through of the physical plant inside and out to ensure compliance with Title 22 regulations. LPA observed resident bedrooms to be fully furnished, clean, and organized. Resident bathrooms were observed to be stocked with hygiene supplies, a trash can, skid mats, hand rails, and shower chair. Common areas were fully furnished. LPA Valerio observed where medications, cleaning supplies, files, and sharps will be locked and inaccessible to residents. Exterior areas were observed to be furnished with areas for outside activities. No emergency exits were obstructed. Fire extinguisher, Carbon Monoxide detectors, and fire extinguisher were in working condition. Component III was conducted and completed with Licensee Vivek. Licensee Vivek had no further questions. Pre-Licensing is complete and this facility has no deficiencies. An exit interview was held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 29, 2024