Lush Care-Riverhaven

Type of visit: Required - 1 Year

On 12/09/2025, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced post-licensing and annual inspection. LPA Lee met with Administrator Shabana Buksh and explained the purpose of the visit. The Administrator Certificate # is 6069964749 and will expire on 05/07/2026. The current census is 1 resident with 1 facility staff. This facility is a single-story building licensed to serve six (6) ambulatory residents only and hospice waiver approved for 2. LPA Lee inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room, garage, staff office and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA Lee observed the facility to be free of odor, clean and in good repair. LPA Lee observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA Lee toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 119.3 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. The smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in kitchen and was last serviced on 09/22/2025. LPA Lee observed the facility has a has a public telephone in the common area. Facility thermostat was observed at 75 degrees Fahrenheit, which is within the required regulation of 68 to 85 degrees Fahrenheit. LPA Lee observed toxins located in laundry and kept locked and inaccessible to residents. LPA Lee observed sharp knives kept locked in the kitchen cabinet and inaccessible to residents. CONTINUED LIC 809-C LPA Lee observed that the entry door and the exit door in the living room that lead to the backyard did not have a single-action mechanism for unlocking and opening. The administrator stated they will remove the secondary lock on both doors to ensure compliance. LPA Lee informed the administrator that all emergency exits must operate with a single-action mechanism. LPA Lee also observed that the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) was in the incorrect size and needs to be in the size of 20" x 26" in size. Administrator stated they will have the Pub 475 enlarge to the correct size and have it posted. LPA Lee checked medication storage and found medication to be locked away and inaccessible to residents. The first aid kit was checked and contained the required components. LPA Lee reviewed medications for 1 out of 1 resident by comparing the medications on hand with their Medication Administration Records (MARs) and confirmed that all records were accurate and complete. LPA Lee reviewed 1 out of 1 resident file, and it was incomplete. Resident 1 (R1) is missing their TB test. Administrator stated that she will reach out to R1’s primary care provider and the R1’s responsible party to obtain a copy of R1 current TB and should if one is not available ensure that R1 has an appointment to get their TB test completed. LPA Lee reviewed 2 staff files, and it was also complete. The following documents will be email to LPA Lee at pang.lee@dss.ca.gov by 12/16/2025 end of day 5:00 PM. (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (4) LIC 610 Current Emergency Disaster Plan (5) Proof of Current Liability Insurance (6) LIC 500 Current Personnel Report As a result of this annual and post-licensing visit , the facility is not in compliance with Title 22 Regulation, and the deficiency can be found on the LIC 809-D page. An exit interview was conducted with Administrator Buksh and a copy of these LIC 809 reports, LIC 809-D page, and Appeals rights were provided to the facility.the state’s words, verbatim · CDSS document, Dec 9, 2025

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Prelicensing

On 12/09/24, Licensing Program Analyst (LPA) Kimberly Viarella made an announced prelicensing inspection. LPA identified herself upon arrival, stated the purpose of the visit and met with the Licensee/Administrator, Shabana Buksh. A brief interview followed. The facility has applied for a license for 6 ambulatory residents with a hospice waiver of 2. LPA conducted an inspection of the facility including but not limited to the 3 resident bedrooms, office, and two bathrooms, all of which contained the required furniture, furnishings, and lighting to be in compliance at the present time. The kitchen, living room, dining room, laundry room, and garage were also inspected. LPA observed the locked closet where medications for future residents will be stored so that they remain inaccessible to residents in care. LPA also inspected the first aid kit and it contained all of the required items to be in compliance at the time of this inspection. This facility had no bodies of water or outbuildings present on its grounds. LPA conducted an inspection of the perimeter and found the exterior to be in good repair and the grounds to be free of debris. LPA Viarella noted no health and safety concerns at this time. LPA Viarella conducted the Component III portion of the application process and will notify the CAB analyst that the Pre-Licensing is complete and this facility has no deficiencies. Per California Code of Regulations (CCR) - Title 22, no deficiencies were observed. An exit interview was held, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 9, 2024

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INTL Capacity: 6 Census : 0 Method: Telephone call with CAB COMP II Participants: Shabana Buksh (Administrator/Licensee) & Tammy Edwards (Analyst). Administrator/Licensee participated in COMP II via telephone call with CAB analyst. Identification of the Administrator/Licensee was verified by confirming driver’s license number. During COMP II, Administrator/Licensee confirmed the understanding of Title 22. Component II was successfully completed. Administrator/Licensee was advised to email signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Administrator/Licensee'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 readiness Applicant Not allowed to accept dementia residents with ambulatory only clearancethe state’s words, verbatim · CDSS document, Oct 15, 2024