La Sierra Senior Home

Type of visit: Required - 1 Year

On 07/16/2026 at 9:00 AM, Licensing Program Analyst (LPA) Beena Singh made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Singh met with Licensee/Administrator Rubina Moosani and was granted entry to the facility. LPA Singh stated the purpose for this visit. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for total capacity of six (6), five (5) non-ambulatory and one (1) bedridden resident. The current census is Three(3) residents. Hospice waiver granted for six(6) residents, no residents on hospice at present. LPA was accompanied by Licensee/Administrator Rubina Moosani to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). The facility is a one storey house with four (4) bedrooms, one (1) Licensee bedroom two (2) resident bathrooms, a living room, dining area and kitchen. There was an attached two car garage on the front of the house. There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 79 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night-stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperature in a resident bathroom to be at 114 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguishers were also observed at the facility. Posters such as personal rights, the CCLD complaint poster, Ombudsman poster, labor laws were posted in a common area. ***Continuation in LIC809C *** Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine cabinet for the residents’ medications locked. Food Service: More than seven (7) days’ supply of non-perishable foods and more than two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. Care & Supervision: The facility has sufficient number of staff to provide care and supervision to the residents in care. Record Review: LPA Singh reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. No issues observed. LPA reviewed Licensee/Administrator Rubina Moosani for First Aid/CPR certification, criminal record clearance, training, and health screenings with Tuberculosis (TB) Test Result. No issues observed. Medications/Medication Administration Record (MAR) were audited for three (3) residents. No issues observed. Annual Fees Current. Liability Insurance valid through 11/26/2025 to 11/26/2026. Fire/Earthquake drill was conducted on May 2026. Based on the observations made during today’s visit, no deficiencies issued per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), was discussed and provided to Facility Licensee/Administrator Rubina Moosani.the state’s words, verbatim · CDSS document, Jul 17, 2026

Type of visit: Prelicensing

On 07/2/2025 at 1:30 pm Licensing Program Analyst (LPA) Beena Singh conducted an announced visit to the facility for the purpose of a Pre-Licensing evaluation. LPA Singh met with Administrator RUBINA MOOSANI. An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to the Central Applications Bureau (CAB) on 12/26/2024, for a total capacity of six (6) five (5) non-ambulatory and one (1) bedridden resident. Fire clearance was granted on 30/04/2025. LPA Singh observed the following: Structure: The facility is a one storey house with four (4) bedrooms, one (1) Licensee bedroom two (2) resident bathrooms, a living room, dining area and kitchen. There was an attached two car garage on the front of the house. Heating /Cooling System: Central heating and air conditioning system installed with a control panel located in the garage of the facility. Bedrooms: Bedrooms three (3) will accommodate one(1) bedridden, bedroom two(2) and three(3) will accommodate four (4) non-ambulatory residents are adequately furnished with bed, closet, appropriate linens and adequate lighting. Night lights were observed in the facility and will be placed in the hallways leading to residents' shared bathrooms. Bathrooms: There are two (2) bathrooms for the residents which have working toilets, a wash basin, and shower with an adequate supply of paper towels, toilet paper, and soap. The water temperature was measured at 105 degrees Fahrenheit in the resident’s bathroom. Kitchen: The kitchen has an adequate supply of dishes, glasses, utensils, pots and pans were observed. Knives/sharp and hygiene care items were secured in a locked drawer located in the kitchen. There was an adequate room for food storage. LPA observed the stove to be operational. Refrigerator(s)/freezer(s) were in working condition. There was sufficient storage for perishable food. There was adequate seating for meals for all residents. Laundry: There is a laundry room with a washer and dryer. Laundry detergents and cleaning supplies will be locked in the laundry room, which can be locked from the exterior door. Living /Family Room: There are two(2) living/family rooms with a TV and adequate seating for all residents. Residents Activities and furniture are placed in the living area for the residents. Linens and Hygiene: An adequate supply of linens was stored in a cabinet in the main hallway of the residence. Yards/Outdoors: There is sufficient covered seating area in the backyard. The gate on the right side is the exit and is self-latching. There is a storage/staff unit in the backyard. All outdoor pathways were free of obstructions. Emergency Phone Numbers and Exit Plan: Facility sketches were observed posted in the main living room area. There was (1) fire extinguisher and five (5) dual carbon monoxide and smoke detectors which are working and in good condition. General items: Staff/Client records will be stored in a locked cabinet in the Hallway.. First Aid kit with required components is located in the dining room cabinet. Personnel files and medication will be locked in the cabinet in the hallway-passage. LPA observed a facility phone- 951-299-8627 and it was verified to be operational. Emergency water supply and food were observed. The facility has met the requirements according to Title 22 regulations and is ready for licensure. An exit interview was conducted, no deficiencies were cited, Component III was completed during this visit, and a copy of this report was reviewed and provided to the Administrator Rubani Moosani.the state’s words, verbatim · CDSS document, Jul 3, 2025

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Rubina Moosani (Managing Member/Administrator) Interview Method: Virtual interview via Microsoft Teams On May 30, 2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant 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 Applicant/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, May 30, 2025