Diya Senior Care

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management Visit and met with Roberto Valdebenito, staff. The purpose of the visit was to follow up on an exception request for a Foley Catheter for resident R1 that the facility submitted to the Department on 02/27/2026. On 02/27/2026, LPA Marrufo made a telephone call to Administrator (ADM) Bani Kaur. During the telephone call, ADM stated R1 was admitted to the facility on 02/21/2026. ADM stated R1 was in the hospital prior to being admitted to the facility. LPA Marrufo asked ADM why she had not requested an Exception for R1’s catheter prior to admitting R1 into the facility. ADM stated the hospital discharged R1 without notice over the weekend without notifying her. LPA Marrufo requested that ADM submit a formal request letter requesting an Exception for R1’s Foley Catheter, along with other supporting documents. On 03/11/2026, LPA Marrufo received R1’s Physician’s Report via email from ADM. R1’s Physician’s Report states R1 cannot manage his/her own treatment/medication/equipment and includes a comment “needs verbal cues.” R1’s Physician’s Report states that R1’s cognitive condition is “recent stroke.” During visit, LPA Marrufo conducted a welfare check of the residents and reviewed resident records. There are no residents under the age of 59 years old at the facility. A deficiency was cited as per California Code of Regulations Title 22. See LIC809-D page for more information. This report was reviewed with staff Roberto Valdebenito and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Mar 13, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87623(a)(1) · Plan of correction due date: Mar 14, 2026

(a) The licensee shall be permitted to accept or retain a resident who requires the use of an indwelling catheter under the following circumstances: (1) If the resident is physically and mentally capable of caring for all aspects of the condition except insertion and irrigation. This requirement was not met as evidenced by: License did not ensure that R1 had an exception request for his/her Foley Catheter prior to being admitted to the facility, which poses an immediate safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 13, 2026

Plan of correction: Licensee agrees to submit a plan of correction by 03/14/2026 stating how the licensee will ensure that the facility will not accept or retain a resident who requires the use of an indwelling catheter unless the resident is physically and mentally capable of caring for all aspects of the condition except insertion and irrigation. The plan must include how the licensee will ensure that all necessary documents for R1’s Exception Request for a Foley Catheter are submitted.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced Required 1 Year visit and met with Bani Kaur, Administrator. LPA announced the purpose of the visit. LPA observed 2 residents watching tv and 4 residents in there bedrooms taking a nap. The Facility room temperature showed 74 degrees on digital thermometer. During visit, LPA toured the facility inside and out. LPA toured the garage area and observed food storage areas and locked cabinets for cleaning supplies. LPA observed the kitchen area and observed locked cabinets for medications, sharp objects, and cleaning supplies. LPA observed perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA toured three resident bedrooms. Each bedroom had available bedding and clothing storage areas as well as functioning lights. ADM tested the smoke detectors and found the smoke detector to function properly when tested. LPA toured two out of two resident bathrooms. Each bathroom had available soap and paper towels and functioning lights. The water temperatures in the bathroom sinks measured with thermometer at 128.6 F at 1:57 pm, during visit water temperature regulated between 105-125 degrees F. LPA toured the outside area and found the exits to be clear of obstructions. LPA observed fire extinguisher was last serviced on 09/24/25. LPA reviewed Fire and Earth log. The last disaster drill was conducted on 08/02/25. Page 1 of 2 Page 2 of 2 LPA reviewed resident records for 3 residents. LPA reviewed 3 staff records. ADM and LPA reviewed Centrally Stored Medication Record for 3 residents. During visit LPA observed a locked shed used for storage and not as living quarters. LPA observed ramp hand rail that was loose and Staff repaired during visit. LPA observed a first aid kit with gauze and tweezers and scissors and first aid guide book. No deficiency were cited as per California Code of Regulations Title 22. Advisory note was provided. This report was reviewed with Lead staff Roberto Valdebenito, ADM had to leave during inspection and a copy of this report and appeals rights were provided. End of Reportthe state’s words, verbatim · CDSS document, Oct 8, 2025

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff did not maintain complete records for resident. Staff did not dispense medication to resident as prescribed. Staff were unable to effectively communicate with resident due to a language barrier. Licensee unlawfully evicted resident. Staff did not ensure resident's dietary needs were met.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Administrator (ADM) Bani Kaur. On 04/28/2025, the department received a complaint with the above allegations. On 05/01/2025, LPA Marrufo conducted an initial complaint investigation visit. LPA Marrufo obtained a copy of resident R1’s Admission Agreement, which states R1 was admitted to the facility on 10/23/2024. LPA Marrufo obtained a copy of R1’s Physician’s Report, which has a listed exam date of 02/10/2025 and was signed by the physician on 02/10/2025. See LIC9099-C pages for more information. Page 1 of 4. Unsubstantiated LPA Marrufo obtained copies of emails that Administrator (ADM) Bani Kaur sent to R1’s Case Manager (CM) and Care Team. ADM requested R1’s Physician’s Report from CM in emails dated 10/23/2024, 11/13/2024, and 11/19/2024. During interview on 05/01/2025, ADM stated that ADM requested R1’s Physician’s Report from R1’s Care Team multiple times. ADM stated R1’s identification and Medicare were not being approved. ADM stated to have told R1’s Care Team that ADM could no longer wait and took R1 to an urgent care clinic to have a Physician’s Report completed. LPA Marrufo obtained copies of the following emails sent from ADM to R1’s Care Team. On 10/18/2024, ADM emailed R1’s Care Team asking them to ensure that R1 has a 30-day supply of medications. On 11/13/2024, ADM requested R1’s Care Team to provide an update about if R1’s insurance has been updated and that ADM needed R1’s medications refilled as soon as possible. On 02/21/2025, ADM sent an email to R1’s Care Team stating that ADM needed medications for R1. LPA Marrufo obtained copies of R1’s Medication and Administration Record (MAR) for the months of January to March 2025. R1’s MAR states R1 was administered medication M1 every day in January and February of 2025. R1’s March 2025 MAR has horizontal lines from the dates 03/01/2025 to 03/05/2025 and 03/22/2025 to 03/31/2025. Each day from 03/06/2025 to 03/17/2025 indicates R1 was administered a dosage of M1. The March 2025 MAR indicates R1 was hospitalized from 03/18/2025 to 03/21/2025. LPA Marrufo obtained a copy of R1’s Centrally Stored Medication and Destruction Record, which records that R1’s M1 medication had a start date of 03/06/2025. On 05/01/2025, R1 stated during interview that the staff did not understand English. R1 stated the staff’s inability to speak English would result in staff not giving R1 medication according to prescription. Page 2 of 4. On 05/01/2025, LPA Marrufo interviewed R2-R6. R2 stated that the staff speak English and R2 can communicate with the staff. R3 stated some of the staff do not speak good enough English and that is why R3 wants to move out of the facility. R3 stated R3’s case worker had to speak to the staff in Spanish about the medications. R4 stated all the staff speak English to some degree. R4 stated staff inability to effectively communicate has led to issues with medications. R5 stated the language barrier of the staff has not been an issue. R6 stated 3 of the staff speak English. R6 stated to have never experienced staff being unable to provide proper care and supervision because they were not able to effectively communicate with residents. During visit on 05/01/2025, LPA Marrufo interviewed S1 in English and did not have any communication issues with S1. During visit on 06/04/2025, LPA Marrufo interviewed S2 in English and did not have any communication issues with S2. R1’s Admission Agreement states R1 was discharged from the facility on 03/18/2025. On 03/18/2025, the facility submitted an Unusual Incident/Injury Report (IR) to the department. The IR stated that on 03/17/2025, R1 called 911 at around 10:30 PM and requested to be taken to the hospital. R1 was admitted to a hospital and then afterwards was in an emergency psychiatric facility. On 05/01/2025, LPA Marrufo conducted a telephone interview with R1. R1 stated to have called 911 because “things were getting out of control” and R1 “opted out.” R1 stated that when R1 left the hospital, R1 did not attempt to return to the facility. R1 stated that the facility did not provide R1 with an eviction notice. During interview on 05/01/2025, ADM stated that R1 called 911 and was taken to an emergency psychiatric facility. ADM stated R1 did not attempt to return to the facility after being discharged from the emergency psychiatric facility. Page 3 of 4. On 06/04/2025, LPA Marrufo conducted a telephone interview with R1’s Family Member, FM1, who stated that when R1 left to the hospital, R1 stated to not wish to return to the facility. FM1 also stated to have been told that R1 was not welcomed back in the facility. R1’s Physician’s Report states R1 has a special diet of low sugar and low fat. During interview on 05/01/2025, ADM stated that all residents are given a low sugar and low salt diet. ADM stated that some residents still buy soda on their own. On 05/01/2025, LPA Marrufo interviewed residents R2-R6. R2 stated staff provide R2 with the food that matches R2’s diet. R3 stated to not know if staff give R3 a low-fat diet. R4, R5, and R6 stated to not have a prescribed diet. On 05/01/2025, LPA Marrufo interviewed staff S1, who stated that when R1 lived at the facility, there was a list of R1’s restricted foods on the facility refrigerator. R1 stated there was a list of R1’s restricted foods above R1’s beds, but R1 tore it off. R1 stated the rule given by ADM to the staff is that food should be no sugar and no salt. During visit on 05/01/2025, LPA observed residents being served a meal of mashed potatoes and chicken. On 06/04/2025, LPA Marrufo interviewed S2, who stated to not put any salt or sugar in residents’ meals. Based on information from interviews conducted with staff, residents, and a witness, and records reviewed, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated. No Deficiencies were cited under California Code of Regulations Title 22. This report was reviewed with ADM Bani Kaur and a copy of this report was provided. Page 4 of 4. END REPORTthe state’s words, verbatim · CDSS document, Jun 4, 2025 · control 26-AS-20250428103647

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced Case Management - other visit and met with Administrator Bani Kaur (ADM). The purpose of today's visit is to collect more information regarding the 30 days eviction letter that the facility issued to resident R1. On 11/15/2024, the Department received a notice from Administrator Bani Kaur (ADM) that the facility issued a 30 day eviction letter to resident R1 due to the facility is unable to provide the level of care to R1. On 11/11/2024, the facility issued a 30 day eviction letter to R1. The reasons of the eviction are resident R1 violated the Admission Agreement and the house rule. LPA toured the resident rooms. LPA interviewed ADM, 2 staff (S1, S2), and 3 residents (R1, R2, R3). LPA request resident's ID form, pre assessment form, physician report, appraisal needs and service plan, incident reports, functional capability form, and progress notes. Exit interview was conducted with ADM. The report was provided to ADM to review. A copy of the report was provided to ADM.the state’s words, verbatim · CDSS document, Nov 21, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) conducted an unannounced annual inspection visit and met with Administrator (ADM) Bani Kaur. LPA inspected 3 staff files and 3 residents files. LPA toured the facility with ADM. Personal rights poster, Licensee, Administrator Certificate were observed at the main entrance. 3 shared resident bedrooms, two restrooms, and laundry room were inspected. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet, knives closet were observed locked. Room temperature was at 70 degree F, and hot water temperature was at 112 degree F in facility. 2 staff and 5 residents were observed in the facility. 3 staff rooms, one restroom, and 1 storage room were observed on the second floor. One of the staff S1 was observed without health screening record. ADM stated S1 has the health screen form. ADM stated he/she will provide a copy of it later. Fire extinguisher was serviced on 09/9/2024. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were working fine. First aid box and flash lights were observed in the facility. The last time the facility conducted the emergency drill is 5/1/2024. Front yard and backyard were inspected. There was no obstruction to block the walkways. Exit interview was conducted with ADM. The report was provided to ADM for signature.the state’s words, verbatim · CDSS document, Oct 28, 2024

Allegation investigated: Staff slapped resident with open hand. Staff pushed resident causing fall injury.

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the investigation findings and met with Administrator (ADM) Bani Kaur. On 1/24/2024, the Department received a complaint with the allegations that staff slapped residents with open hand and staff pushed resident causing fall injury. On 2/1/2024, the Department conducted an initial investigation visit. LPA interviewed ADM, 3 staff and 6 residents. LPA toured resident rooms and requested the roster of clients, LIC500, resident's physician report, appraisal Needs and Service plan. Continue on LIC9099-C. Page 1 of 3. Unsubstantiated Staff slapped resident with open hand: Staff pushed resident causing fall injury: The allegations are that the facility staff slapped a resident's head with open hand, and the facility staff pushed the resident R1's door of the bedroom and hit the resident R1 causing fall injury. On 2/1/2024, LPA interviewed resident R1. R1 stated on 11/20/2023 night, a staff opened his/her bedroom door without permission. R1 was at the back of the door and was hit. R1 stated he/she felt pain but did not fall down. R1 stated on 12/14/2023, he/she was in the bedroom watching his/her tablet. R1 stated S1 came in the room and took the tablet. R1 stated he/she got it back and S1 slapped his/her head. R1 stated he/she did not get injuries. LPA interviewed 5 residents. 1 out 5 residents just moved in the facility for 3 days and was unable to answer the questions. 3 out 5 residents stated they did not see any staff hit or slapped residents. 1 out 5 residents stated he/she heard residents R1 and staff S1 had altercations, but he/she did not see S1 hit or slapped R1. LPA interviewed staff S1. S1 stated he/she is a night shift staff. S1 stated he/she needs to provide supervision to residents to make sure residents were sleeping in the rooms, and to make sure the head count is correct. S1 stated on 11/20/2023, he/she opened R1's bedroom door and the door hit R1. S1 stated it was not a hard hit and R1 did not fall down. S1 stated on 12/14/2023, he/she entered R1's bedroom because R1 was making noise by watching movie on R1's tablet. S1 stated he/she took R1's tablet but R1 took it back immediately. S1 denied he/she slapped R1. LPA interviewed 2 staff (S2, S3). Both stated they did not see S1 hit or slapped R1. Continue on LIC9099-C. Page 2 of 3. LPA interviewed Administrator (ADM). ADM stated on 11/20/2023, staff S1 opened R1's bedroom and the door hit R1. ADM stated R1 did not fall down and did not get injury. ADM stated S1 is a night shift staff and needs to make sure residents were sleeping in the bedrooms. ADM stated after the incident, staff received the training that staff should open the door politely and don't enter the rooms if no permission or not necessary. ADM stated on 12/14/2023, R1 made noise by watching movie on his/her tablet. ADM stated S1 took R1's tablet and R1 took it back immediately. ADM stated S1 denied he/she slapped on R1. Based on review of Law Enforcement Task Report, it is unable to determine if the allegations did happen or not, and there are no sign of injury or abuse on R1. Based on the interviews and record reviewed, there is no sign of injury or staff abused on R1 and it is unable to determine if the allegations did occur or did not occur. Based on investigation, interviews conducted and records reviewed , the Department found that the above allegation is UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. No citations noted at today’s compliant investigation visit. Exit interview conducted with ADM. A copy of this report was provided to ADM. Page 3 of 3. Facility did not report incident to CCLD: The allegation is that the facility did not report incident to CCLD. On 2/1/2024, LPA interviewed Administrator (ADM). ADM stated for 11/20/2023 incident, he/she interviewed with other residents and other staff except R1 and S1. ADM stated no stated that they saw S1 hit R1. ADM stated it was an accident that a staff opened the door and hit resident R1 accidentally, and R1 was not injured. ADM stated for 12/14/2023 incident, he/she did not receive any report about the incident. ADM stated no other staff and resident saw or heard the incident. ADM stated on 1/24/2024, police officers came to the facility to interview staff and residents, then he/she knew the incident. ADM stated on 1/25/2024, he/she sent the incident report to CCLD office. LPA checked the incident reports sent to CCLD office, LPA found the incident report that the facility sent to CCLD office. Based on interviews and record reviewed, no evidence to indicate the facility did not report incident to CCLD. Facility staff confiscated resident's personal property: The allegation is that facility staff confiscated resident tablet. On 2/1/2024, LPA interviewed resident R1. R1 stated on 12/14/2023, staff S1 took his/her tablet but he/she took it back immediately. LPA interview staff S1. S1 stated on 12/14/2023, he/she took R1's tablet but R1 took it back immediately. Based on the interviews, S1 did not confiscated R1's tablet. Based on the interviews and documents reviewed, no evidence to indicate the facility is in financial distress. Continue on LIC9099-C. Page 2 of 3. The Department has investigated the above allegations. Based on the investigation, observations, records reviewed, and interviews conducted, the Department found that the above allegations are UNFOUNDED, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. No citations noted at today’s compliant investigation visit. Exit interview was conducted with ADM. This report was provided to ADM for signature. Page 3 of 3.the state’s words, verbatim · CDSS document, Oct 8, 2024 · control 26-AS-20240124141044

Allegation investigated: Facility is in financial distress.

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the investigation finding and met with Administrator (ADM) Bhupinder Kaur. On 09/01/2023, the Department received a complaint with the allegation that the facility is in financial distress and did not pay staff salary on time. On 09/07/2023, the Department conducted an initial investigation visit. LPA interviewed ADM and 2 staff. LPA obtained the facility utilities paid bill and balance, insurance paid bill, staff paid checks and the facility bank statement. Continue on LIC9099-C. Page 1 of 2. Unfounded On 9/7/2023, LPA interviewed 2 staff (S1, S2). Both staff stated they don't get the pay check on the first day of the month and the 16th day of the month. Both stated they received the pay checks 5 days later or even longer after the first day or 16th day of the month. LPA interviewed Administrator (ADM). ADM stated he/she uses payroll service company ADP to help for the facility pay checks that most of the small companies used for payroll service. ADM stated he/she calculates the staff working hours of the time period and sends to the company ADP. ADM stated usually it takes 5 days for ADP to process and made the pay checks available. ADM denied he/she did not pay the staff. ADM stated the staff misunderstand that they will get paid the next day of the working period. ADM stated the facility is not in financial distress. Reviewed the facility utilities bill statement, insurance bill statement, bank statement, all the transactions looks fine. The facility is not in a financial distress condition. ADM provides the copies of all staff 3 month pay checks. Reviewed the facility staff pay check documents, the paid day of the pay checks always on the 5th day of the month and on 5th day after the 16th day of the month. There are no missing checks for staff. Based on the interviews and documents reviewed, no evidence to indicate the facility is in financial distress. The Department has investigated the above allegations. Based on the investigation, observations, records reviewed, and interviews conducted, the Department found that the above allegations are UNFOUNDED, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. No citations noted at today’s compliant investigation visit. Exit interview was conducted with ADM. This report was provided to ADM for signature. Page 2 of 2.the state’s words, verbatim · CDSS document, Sep 17, 2024 · control 26-AS-20230901124955

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced Case Management -other visit and met with Administrator Bani Kaur (ADM). On 8/1/2024, around 9:30AM, resident R1 left the facility, and stating he/she is going out and will come back soon. R1 had a cell phone with him/her. R1 did not return to the facility after the curfew time. R1 came back to the facility on 8/2/2024, around 10:00AM by himself/herself. CCL office received the incident report regarding R1 on 8/6/2024. On 8/9/2024, LPA interviewed Administrator (ADM). ADM stated R1 is independently to leave the facility by self. ADM stated on 8/1/2024, R1 told the staff that he/she was going out and will be back soon. ADM stated R1 had cell phone with him/her at that time. ADM stated after the curfew time on 8/1/2024, staff found R1 still outside the facility. ADM stated staff called R1 several times but did not go through. ADM stated staff search around the neighborhood but were unable to find R1. ADM stated staff called police. ADM stated R1 returned to the facility on 8/2/2024 around 10:00AM by himself/herself. ADM stated R1 is fine after R1 returned to the facility. LPA requested R1's physician report and appraisal/needs and service plan. Reviewed R1's physician report dated 5/6/2024, it specifies R1 "able to leave facility unassisted". ADM stated the facility is updating R1's care plan. ADM stated she discussed with R1 and R1's case manager regarding the incident. ADM stated R1 agrees to return to the facility by 8:30PM every day, and he/she will call the facility in advanced if he/she cannot make it. Exit interview was conducted with ADM. The report was provided to ADM for signature.the state’s words, verbatim · CDSS document, Aug 9, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) conducted an unannounced annual inspection visit and met with Administrator (ADM) Bani Kaur. LPA inspected 5 staff files and 5 residents files. LPA toured the facility with ADM. Personal rights poster, Licensee, Administrator Certificate were observed at the main entrance. 3 shared resident bedrooms, two restrooms, and laundry room were inspected. The window screens in 2 out of 3 resident bedrooms were observed not in good repair. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet, knives closet were observed locked. The closet under the sink in the kitchen was observed unlocked. Room temperature was at 72 degree F, and hot water temperature was at 110 degree F in facility. 3 staff rooms, one restroom, and 1 storage room were observed on the second floor. One of the staff was observed without health screening record. The staff files and residents files were not placed in the facility. ADM brought the staff files and resident files from other place to the facility for inspection. Fire extinguisher was serviced on 09/11/2023. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were working fine. Front yard and backyard were inspected. There was no obstruction to block the walkways. Deficiencies were noted today. See LIC809-D. Exit interview was conducted with ADM. The report was provided to ADM for signature.the state’s words, verbatim · CDSS document, Oct 12, 2023