Rai Angels

Allegation investigated: Staff are not following physician's order.

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to investigative findings to a complaint received on January 15, 2026 and met with lead staff, Yasmin Bennett. Also present was staff, Vetelan "Janet" McCubbin. LPA spoke to Administrator, Balwinder Rai, by phone LPA observed (1) resident in the common area at the start of the inspection. There is (1) resident under hospice care. During the investigation, LPA interviewed (1) facility staff (S1) and the Administrator. LPA also reviewed documentation pertaining to resident (R1), including the physician's report, care plan, narrative charting notes, medication orders and the Medication Administration Record (MAR). The results of the investigation are as follows: (R1) moved to the community on July 17, 2025 with a diagnosis of Vascular Dementia, Schizoaffective Disorder, Diabetes Mellitus 2 and required assistance with bathing, dressing/grooming, and toileting. *cont on 9099C-1.. Substantiated 9099C1-. Allegation: Staff are not following physician's order. The allegation states that staff are not following resident (R1’s) dietary plan, including serving soft foods and cutting food in small bites, and with serving too many Ensure drinks at a time. The family member stated she signed the care plan which notes (R1) has "aspiration precaution, is at risk due to crackers", the caregiver stated (R1) can swallow Ramen noodles fine, and they are not cutting them; however, resident's Home Health provider said to cut the food in small pieces, and they only do sometimes. The family member stated one time when she visited, (R1) was eating a whole Persimmon, and the facility is "not following orders for aspiration as they gave him ice-cream last Thursday (1/15/2026), and they are supposed to put thickener in it". Additionally, staff are "supposed to cut bite sized sandwich pieces and they gave it to (R1) whole", staff gave (R1)(6) Ensure drinks in one day" due to being "combative". The family member commented that due to (R1) being at risk for sugar, she told staff (R1) should have no more than (3) Ensure drinks each day. On 1/20/26, Staff (S1) confirmed (R1) has "swallowing concerns" and she/staff use "thickener", showing LPA the bottle. Charting notes from 12/9/2025 note there is an order for (3) bottles of Ensure per day, and to continue thickening all liquids. (S1) stated "Yes, I do go over 3 per day because I don't want to be in an argument with him". On 1/20/26, LPA observed all residents to be served a whole sandwich cut diagonally, and (R1) to be eating their soup first. LPA asked (S1) about cutting (R1's) sandwich into bite sized pieces to which (S1) replied "(R1) can eat bites" but agreed to cut the sandwich, adding 'it doesn't have to be bite sized" and commented that (R1) "has improved" and the Speech Therapist did a reassessment and (R1) tends to not chew and just swallow" and stated he hasn't choked in a long time". On 2/23/26, (S1) stated (R1's) diet consists of "regular to soft foods and staff do cut food for him as well as place thickener in all his liquids". Charting notes made on 12/2/2025 and 12/9/2025, document the instructions from Speech Therapists for swallowing safety as: “All foods must be soft and in bite size”. The Administrator stated "staff is cutting it in small pieces- they will puree it if the food is tough to eat, such as a steak, and commented (R1) "always eats in a hurry" and on the discharge paperwork (dated 7/25/25), the diet states to cut it in bite sized pieces. (R1's) Care Plan notes resident is at risk for choking and states resident requires supervised eating/drinking and monitoring, encouragement and/or cueing and resident is prescribed a “mechanical soft diet”. *cont on 9099C-2.. 9099C-2..On 3/26/2026, (S1) confirmed (R1) receives no more than (3) Ensure drinks daily and commented (R’1s) family member brought Glucerna (low sugar) to the facility on Tuesday, (3/24/26), and (R1) is given the Glucerna 3x/day, per previous prescriptions. On the same day (12:00 pm). LPA observed staff and the Administrator reminding (R1) to take small bites during lunch. Based on information obtained, LPA finds the allegation to be SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. Exit interview by phone with the Administrator. Care staff authorized to sign today's report that was provided. 9099A-C-1.. LPA reviewed (2) staff's training records. Documentation showed that both staff had completed the required initial and continuing training requirements for residents with Dementia. The Administrator stated (6) hours of Dementia care included (2) hours in each of the following areas: Recognizing symptoms that may create or aggravate dementia behaviors; Recognizing the effects of medications commonly used to treat dementia symptoms and their impact on the behavior of residents with dementia, and Responsiveness to the general security and supervision of dementia residents. Staff (S1) stated on 1/20/26, that (R1) takes Seroquel and Trazadone which were recently increased (each dosage) and is sleeping better now. (S1) stated (R1) has been physical, has had outbursts since July 2025, and each outburst will normally last 1 hour. On 1/20/26, (S1) stated (R1)was sent out on January 14, 2026, last week, for outbursts and aggression that lasted 18 hours- (from 12 noon until 6 am the following morning) and (R1's) family member enrolled them back in Home Health yesterday, January 19, 2026. Als0o, Seroquel was increased due to OCD (Obsessive Compulsive Disorder) diagnosis- (R1) receives 3x/day- morning, noon and bedtime (which has/is helping). On 2/23/2026, the Administrator was asked about staff training specifically related to handling resident outbursts and responded, "staff know how to handle (R1's) outbursts it is easy to redirect them". The administrator and (S1) confirmed that (R1) would "always put a chair by the closed door" and did this at the prior care home. The administrator indicated she put a lock on (R1's) door, as they requested, following the incident on January 14, 2025 and (R1) "will close and lock the door" but then will unlock the door. Charting notes document (R1) had outbursts on the following days: Jan 12, 2026 (2:00 pm for a “period of continued agitation”), January 1, 2026 (at 12 am and 11 am), and on July 27, 2025 when they were sent to Emergency Room. LPA was not provided with any documentation for specific training related to behaviors caused by diagnoses other than Dementia. LPA recommends staff complete training for behaviors associated to other diagnoses. Based on information obtained, the allegation is found to be UNSUBSTANTIATED- which means that Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. *cont on 9099A-C-2 9099A-C-2... Staff did not ensure that resident received prescribed medication. The allegation states that staff are not making sure that resident (R1) is taking their medication as one of the medication pills were found. The family member stated the caregiver told a friend she found a medication pill on the floor and (R1) will "pretend to take meds". The family member stated that staff says (R1) doesn't sleep, there is a Melatonin prescription, but she was out of town and not able to pick it up, and (R1) takes "Trazadone, PRN, for combativeness and she was present with Home Health was initiated. Staff, (S1) indicated to LPA that (R1) does pretend to take their medications and confirmed she has taken medication training. LPA reminded (S1) that staff must stay when administering medications to ensure each resident actually swallows them. (S1)also indicated she documents when medications are refused. On 1/20/2026. (S1) stated (R1's) family member enrolled them back in Home Health yesterday, 1/19/2026, and there were some medication changes. Seroquel was increased due to OCD (Obsessive Compulsive Disorder) diagnosis to three times daily- morning, noon and bedtime, which has been helping. Physician's orders, 1/14/26, following an Emergency Room visit state: Seroquel (Quetiapine 50 mg) is to now be given (1) tablet (50 mg) twice a day (morning and with lunch) and (5) tablets (250 mg) every night.; stop medications, Fluvoxamine 25 mg (Luvox) and Mirtazapine 15 mg (Remeron), and to continue with Divalproex 500 mg, twice daily; Melatonin ODT 10 mg nightly; Rivastigmine 9.4 mg patch; A new PRN, Trazadone 50 m,was ordered, up to 3 times a day, as needed, for mild agitation and insomnia. On 2/23/2026, (S1) stated (R1) is taking their medications without any issues and there have been no recent changes. Based on information obtained, the allegation is found to be UNSUBSTANTIATED- which means that Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. *cont on 9099A-C-3... 9099A-C-3... Allegation: Staff do not provide adequate incontinent care. The allegation states that (R1's) "wheelchair was filled with resident poop, there was stool in (R1's) underwear" and staff are "not cleaning" up after (R1's) has a bowel movement. Staff, (S1), stated "(R1) had an accident one time, but on a regular basis, they can clean themself". (S1) explained the one time (R1) had an accident was when they were going to the doctor's office, on 12/8/2025, and the daughter saw a stain on his clothes”. (S1) explained (R1) "hurries and didn't wipe". On 1/20/26, LPA observed (S1) to be asking (R1) if they "wiped and washed their hands" following using the restroom. (S1) stated also on 1/20/26 that (R1) "needs some assistance with toileting" and asserted that (R1's) condition "has improved since moving in", including their blood sugar and blood pressure. The Care Plan (dated 11/10/2025) notes (R1) is “independent” with toileting tasks but is dependent with personal hygiene and requires partial staff physical assistance with completing personal care. The physician's report (7/20/2025) notes (R1) is incontinent x2 and is not able to care for their own toileting needs, and caregiver assistance is required for bathing, dressing, grooming. On 2/23/26, the Administrator stated staff "always checks on (R1)" who will tell staff if they are going to have a bowel movement, so they can assist with cleaning (R1). (S1) asserted "we are always checking on them" and will ask (R1) if they washed their hands, cleaned themself after going to the bathroom once they leave the bathroom. Staff further commented, "we always give a shower to the resident before a medical appointment" and confirmed (R1) must have used the restroom after he received a shower that day (Dec 8, 2025). (S1) stated on 2/23/26, that (R1) is "100% agreeing to taking more showers now than a month ago". LPA did not observe any incontinent odors during the inspection on January 20, 2026, February 23, 2026 March 26, 2026, or on April 17, 2026 when at the facility. The Administrator stated the family member called her and told her about (R1) having some stool residue in their under garments, but it was not certain when this occurred. Photo evidence was not provided to LPA. Based on information obtained, the Department finds the allegation to be UNSUBSTANTIATED- which means that Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Exit interview. Care staff authorized to sign today's report that was provided.the state’s words, verbatim · CDSS document, Apr 17, 2026 · control 59-AS-20260115125813

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(10) · Plan of correction due date: May 1, 2026

87555 General Food Service Requirements (b) The following food service requirements shall apply: (10) Where indicated, food shall be cut, chopped or ground to meet individual needs. This requirement is not met as evidenced by: Based on interviews conducted, the Licensee did not ensure that resident (R1) did not receive more than (3) Ensure drinks per day, as ordered, on at least one occasion, on/around December 2025- January2026, which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 17, 2026

Plan of correction: Licensee/Administrator agree to provide training to staff to ensure resident orders regarding special diets are being followed. Staff training due to LPA by 5/1/2026.

Allegation investigated: Staff did not administer resident's medication.

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver findings to a complaint received on March 18, 2026, and met with Administrator, Bali Rai. Also present were staff, Yasmin Bennett and Vetelan "Janet" McCubbin. LPA observed (1) resident in the common area and (4) residents resting in their rooms. During the investigation, LPA interviewed the Administrator, (1) staff, the Ombudsman, and an individual who is familiar with prior resident (R1). (R1) resided at the facility for a respite stay of (2) weeks, to recover after surgery, and was not availble for an interview. LPA reviewed documentation related to (R1), including the Physician's Report, Hospital discharge paperwork and Medication Administration Record (MAR) for March 2026. The Physician's Report notes that (R1) needs assistance with storage and administration of pain medications and does not have any cognitive loss. The results of the investigation are as follows: Allegation: Staff did not administer resident's medication. The allegation states that resident (R1) asked for their medications on the night of March 16, 2026, and was told "No" by staff. *cont on 9099C-1.. Unfounded 9099C-1..Staff (S1) stated she was on vacation from March 8, 2026 through March 13, 2026 so did not see (R1) for about half the time they were at the care home, and confirmed (R1) moved out on March 19, 2026. (S1) stated the Ombudsman came by twice and the second time (R1) requested the case be dropped. (S1) stated that (R1) was fully cognitive and explained (R1) was taking several PRN medications- Oxycodone, Tylenol and Ibuprofen. (S1) stated PRN Oxycodone was to be taken every (6) hours, and (R1) "always asked for Oxycodone" for pain following surgery on their arm. (S1) explained "(R1) was supposed to ask" for all PRN medications and so staff didn't automatically administer it, confirming she would give (R1) their "am" meds when they returned at 10:00 am and and later their dinner meds. Both the Administrator and (S1) stated (R1) would leave the facility at 6:00 am to go to the clinic and would return anywhere between 10 am- 3 pm, as it varied. The Administrator stated she was here daily from March 7, 2026 through March 13, 2026, which is reflected on the MAR, (R1) would always ask for medication when they were in pain and staff would always administer it to them. The MAR shows that (R1) received Oxycodone on March 8, 2026 (3:00 am). An individual who is familiar with (R1) stated that they felt (R1) was "pretty credible" in what they stated about the PRN medication not being given and confirmed that (R1) stated there was only an issue with medications not being given on 3/16/2026, at bedtime. Physician's orders show there were no scheduled medications to be administered at bedtime. The MAR for March 2026 reflects that all scheduled medications were given, except when (R1) was out of the facility. In addition, the MAR shows PRN Oxycodone 10mg was administered, at different intervals, starting on March 5, 2026 through March 15, 2026 (5:00 pm) and was not ever administered at 8:00 pm. Tylenol 325mg was administered multiple times from March 5, 2026 through 7, 2026, including one time at 8:00 pm, and once on March 14, 2026. Ibuprofen was administered one time, on March 6, 2026 (5:00 pm). The MAR shows that (R1) missed medications on the morning of March 16, 2026 but received medications at 5:00 pm that day, and the last medications administered were on March 19, 2026 in the morning, prior to (R1) moving out. Based on information obtained, LPA finds this allegation to be UNFOUNDED- meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Mar 26, 2026 · control 59-AS-20260318114827

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection and met with lead staff, Yasmin Bennett and staff Vetelan "Janet" McCubbin. Administrator, Bali Rai, arrived shortly to the facility. LPA observed (1) resident in the common area and (4) residents in their rooms at the start of the inspection. The facility is licensed for (3) bedridden residents, (3) non-ambulatory residents and is approved for (6) hospice residents. Currently, there are (0) residents under hospice care. LPA and Administrator toured the interior/exterior of the facility including the common areas, (4) private resident bedrooms, (1) shared resident bedroom, (3) full resident bathrooms, (1) half resident bathroom, kitchen, laundry/garage. LPA observed the facility to be clean, in good repair and be odor free. Bathrooms have the necessary grab bars, skid-resistant flooring, and hygiene supplies. There is a non-audio camera in common areas. There is 2+day perishable, including fresh produce, and 7+ day non-perishable food. Sharps, medications and toxins are secured in the kitchen, and additional toxins are locked in the laundry area. Hot water measured 114*F in the kitchen. Inside temperature measured 72*F. Smoke/monoxide alarms are working- the fire door automatically closed when the alarm sounded. There is a new fire extinguisher on site and a second one will be serviced today. There is (1) unlocked exit gate and covered patio seating. (2) resident files and (3) staff files were reviewed. Files were organized and contained current documentation, including the initial/ongoing staff training. Medications/orders were reviewed for (2) residents- orders match medications being administered. Administrator has current RCFE certificate # 7024835740 (exp 3/22/27). Staff are cleared/associated and have current First Aid/CPR per requirement. LPA obtained current insurance information and requested an LIC308 and LIC500 to be emailed to LPA 4/1/26. There were no deficiencies observed. Exit interview. Copy of report provided to the Administrator.the state’s words, verbatim · CDSS document, Mar 26, 2026

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection and met with lead staff, Yasmin Bennett and staff Vetelan "Janet" McCubbin. LPA was advised all (5) residents were napping at the start of the inspection. Administrator, Bali Rai, arrived shortly to the facility. LPA discussed with lead staff and the administrator (2) incident reports recently and timely submitted to the Department, as follows: Resident (R1) was vomiting late in the evening of March 11, 2026 and requested to go to the hospital. (R1) returned from the hospital the following day(6:45 am). The Administrator stated (R1) vomited twice prior to going to the hospital. The hospital discharge papers stated (R1) was seen for a diagnosis of nausea and vomiting. (R1) has been fine since returning on March 12, 2026 and is taking his medications, eating meals and sleeping well. (R1) has a follow up phone visit with a Registered Nurse on March 23, 2026. Resident (R2) was shaking on March 12, 2026 around 1:00 pm. (R2) was evaluated by Emergency Medical Technicians who determined that (R2's) blood sugar was high. (R2) was admitted to the hospital and returned on March 18, 2026 with a new 30-day order for insulin to replace Metformin tablets. Both the administrator and lead staff stated (R2) is recovering and doing well. (R2's) blood sugar is taken 4 times daily and it has been within a normal range. LPA discussed how more information is needed on the incident report related to after residents were hospitalized and how a report can be submitted up to (7) days following the incident. There are no deficiencies issued in this report. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Mar 20, 2026

Allegation investigated: Staff did not allow resident to use the phone. Staff did not follow physician's orders.

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver investigative findings to a complaint received on September 24, 2025 and met with staff Yasmin Bennett and Nidda Taufetee. The administrator, Balwinder Rai, arrived around 10:40 am. During the investigation, LPA interviewed the Administrator, (4) residents, and a family member of resident (R1). LPA was not able to interview the only staff who was familiar with resident (R1) as they were not currently working at the facility. LPA was also unable to obtain additional specific information from prior resident (R1). LPA reviewed (R1's) care plan, physician’s report and medication list. The results of the investigation are as follows: (R1) moved in on November 6, 2024 and moved to a related facility nearby on November 13, 2024. Resident was sent out to the Emergency Room on December 3, 2024, from the related facility, and did not return to either care home. ** cont on 9099C-1** Unsubstantiated 9099C-1.. Resident (R1’s) Physician’s Report notes a primary diagnosis of Urinary Retention and a foley catheter is needed to assist. (R1) also needs assistance with transfers and dressing/grooming and is able to communicate and follow directions but is not able to leave the facility unassisted. Allegation: Staff did not allow resident to use the phone. The allegation state staff did not allow resident (R1) to use the phone to call out. The administrator stated that (R1) "was using the land line a lot" and they did not have a personal cell phone and asserted "other family members complained of the phone being busy and it not being answered", and it was due to (R1) being on the phone so much. The administrator added that during the day, (R1) was on the phone 1.5 hours sometimes and she "told (R1) they cannot be on the phone that long". The administrator stated (R1) was calling Canada and she told them "don't make too many out of state calls". The administrator confirmed the facility phone is a cordless land line, and (R1) would take the call to their room and was unsure if (R1) was making outgoing or receiving incoming calls. Four (4) residents stated they each use their personal cell phone and do not use the facility land line. (R1s) family member stated he is "not aware" of (R1) not being able to make outgoing calls and stated he called (R1) "numerous times and I was always able to talk to (R1)". Based on information obtained, LPA finds this allegation to be UNSUBSTANTIATED -meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Allegation: Staff did not follow physician’s orders. The allegation states staff would not give (R1) their psych meds or the Flomax for urinary retention; staff stole (R1’s) catheter kits to empty their urine, claiming the kits were for someone else at the facility. The administrator indicated (R1) did not have a catheter, but said they needed one due to having urinary retention. The administrator indicated she is not sure if (R1) moved in with a catheter as they "were using the commode". *cont on 9099C-2.. 9099C-2.. The administrator confirmed that (R1) "had a catheter kit" and "it did not disappear as no one else used a catheter". The administrator was unsure who gave the catheter kit to (R1). The administrator confirmed (R1) was administered medications as ordered and the facility uses a MAR, commenting that (R1) wanted to keep the meds in their room, but she told them they have to be centrally stored. Four (4) residents were asked if the facility administers medications as ordered. One resident said they don’t take any medications, two residents stated staff gives them medications, and a third resident was unsure if staff give them medication due to having a diagnosis of Dementia. (R1s) family member stated "no, not that I'm aware of" when asked if the facility was not giving medications. Hospital documentation shows (R1) went to the ER on 11/11/2024 and was given a diagnosis of Urinary Retention and was requested to schedule an appointment within (3) days with their primary care provider. (R1) moved to a related to a related facility on 11/15/2024. Electronic documentation show that all medications were administered as prescribed from 11/6/24 through 11/13/24. There is no note about (R1) having a catheter on the documentation. Based on information obtained, LPA finds this allegation to be UNSUBSTANTIATED -meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred.the state’s words, verbatim · CDSS document, Oct 14, 2025 · control 59-AS-20250924094337

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection and met with Balwinder Rai, Administrator, and stated the reason for today's inspection. Also present were care staff Yasmin Bennett and Veron Reid, and a hospice nurse for (1) resident. LPA observed (2) residents watching television in the common area and (3) residents in their rooms. The facility is licensed for (3) bedridden residents, (3) non-ambulatory residents and is approved for (6) hospice residents. LPA and the Administrator toured the interior/exterior of the facility including the common areas, (4) private resident bedrooms, (1) shared resident bedroom, (3) full resident bathrooms, (1) half resident bathroom, kitchen, laundry/garage. LPA observed the facility to be clean, in good repair and have sufficient furniture and lighting. Bathrooms have the necessary grab bars, non-skid flooring, soap, paper towels, and hand-washing poster. There is 2+day perishable, including fresh produce, and 7+ day non-perishable food. Sharps and medications are secured in the kitchen. Toxins are locked in the laundry area. Hot water measured 113*F in the kitchen. Inside temperature measured 75*F. Smoke/monoxide alarms are working, and the fire extinguisher was last serviced 3/18/25. There are sufficient linens/towels/blankets/PPE and a complete First Aid kit. There is (1) unlocked exit gate and covered patio seating. There are no pools/ponds. LPA obtained updated facility contact information. (2) resident files and (3) staff files were reviewed. Files were organized and contained current documentation. Initial/ongoing staff training is documented. Medications/orders were reviewed for (1) resident. There were no discrepancies noted, and PRN medications are documented. RCFE Admin #6058964740 is pending renewal (verified). Admin Designee has RCFE #607271174- (exp 10/8/26). The Plan of Operations has the updated Dementia Care Regulations. LPA obtained current insurance information. LIC308 and LIC500 to be emailed to LPA by 4/29/25. There were no deficiencies observed. Exit interview. Copy of report provided to the Administrator.the state’s words, verbatim · CDSS document, Apr 22, 2025

Allegation investigated: Facility is in disrepair. Facility is unsanitary.

Licensing Program Analyst (LPA) Sabrina Calzada and Associate Governmental Program Analyst, Vanne Le, arrived unannounced to complete a complaint investigation and met with caregivers, Veron Reid and Trineesha Buckley, and stated the reason for today's inspection. The Administrator was contacted and arrived around 2:00 pm. (2) residents were observed to be resting in the common areas at the start of the inspection and (3) residents to be resting in their rooms. During the investigation, LPA interviewed the Administrator, (1) staff, resident (R1) and (2) other residents. LPA reviewed documentation related to (R1) including, but not limited to, hospital discharge papers and incident report (from 12/14/24), physician’s report and medication records. The results of the investigation are as follows: Resident (R1) moved to the facility on/around December 7, 2024 and moved out on/around December 19, 2024 as part of a two-week stay only. *cont on 9099C-1.. Unfounded 9099C-1. Allegation: Facility is in disrepair. Allegation states the hallway toilet, which is the only one available for (R1's) use, frequently backs up and contains feces. Resident (R1) stated the toilet is not working well and regularly overflows in their room, and they are only allowed to use the toilet in their room. On December 19, 2024, the toilet was checked by the Ombudsman and found to be flushing correctly. On December 19, 2024, the Administrator confirmed there are (3.5) baths, in resident rooms and showed LPA (2) photos of the toilet in (R1's) room that "overflowed one time" and explained that her maintenance staff "found wipes and (1) sock in the toilet 4-5 days ago". On March 11, 2025, the Administrator stated that a washcloth was found also stuck in the toilet on December 20, 2024. On March 11, 2025, staff (S1) stated that there were issues with (R1's) toilet overflowing a little bit, due to frequent usage and using a lot of toilet paper, and it overflowed one time where there was more water on the floor. (S1) added that (R1) told her in December 2024 that they think their sock was flushed and staff did later find a sock when the toilet was plunged. (S1) stated she is not sure if (R1) did this purposefully, or if it was due to them not being able to see well, and (R1) was advised to stop flushing continuously to prevent any overflow. On March 11, 2025, (4) toilets were checked for flushing correctly and were found to be working. LPA previously inspected the facility in May 2024 and in September 2024 and all toilets were found to be working correctly. On March 11, 2025, LPA interviewed (2) residents. Both residents stated that there have not been any issues with toilets not flushing correctly. Based on information obtained through interviews, the Department finds the allegation to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Allegation: Facility is unsanitary. Allegation states it can take several days for the facility staff to clean the bathroom, raising concerns about hygiene and safety. On December 19, 2024, the Administrator stated that (R1) went "BM on the floor on purpose". Staff (S1) stated that (R1) would usually make a lot of mess on the toilet and floor due to frequent diarrhea. *cont on 9099C-2.. 9099A-C-1... Staff (S1) stated on March 11, 2025 that she was the only staff on shift on December 14, 2024 when (R1) asked to go to the hospital. (S1) stated that (R1) had diarrhea, but it was different in that (R1) stated they needed to go to the hospital because their "stool is black" and they had stomach pain. (S1) stated she offered to clean (R1) up but they refused to be cleaned up as they wanted the hospital to do that. (S1) stated that she observed (R1) to be bent over in pain on the couch after they said they wanted to go to the hospital. (S1) stated she called 9-1-1 first from the house phone to tell them what was happening with (R1) and followed the directions they gave her, including to wait on the phone until the ambulance arrived. (S1) stated she told (R1) she would also be notifying the Administrator and then called the Administrator on he personal cell phone, after calling and being placed on hold with 9-1-1. (S1) confirmed that (R1) was sent out around 11:30 pm on December 14, 2024 and returned around 4:30 am on December 15, 2024 with one of two medications just prescribed. (S1) confirmed that (R1) had the second medication filled shortly after arriving back to the care home. The (2) new meds were prescribed for (3) days each- Loperamide 2mg-take 1 tablet every 4 hours, as needed for loose stool, and Ondansetron 4 mg prescribed -1 tablet every 4 hours as needed for nausea. The incident report submitted to the Department states that (R1) notified the caregiver of having episodes of diarrhea, they soiled their clothes and the toilet, and requested the caregiver call 9-1-1. The report states that the caregiver promptly contacted 9-1-1, at 11:10 pm, and the fire engine arrived at 11:18 pm. The report further states that (R1) was tested at the hospital, results were good, and they returned at 5:14 am on December 15, 2024. The discharge papers confirmed that (R1) did have diarrhea for "one day" had a discharge diagnosis of: Vomiting and diarrhea. The Internal Medicine Discharge Summary- (dated 12/6/24), the day before (R1) moved in, notes that (R1) is a patient with high insulin requirements (discharged with oral medications only given their poor vision/near blindness), and there was a referral placed to GI for chronic diarrhea with possible pancreatic insufficiency. The Administrator stated she instructs staff to always call 9-1-1 first before calling her and she arrives at the facility when 9-1-1 gets hers. Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED -meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. *cont on 9099A-2. 9099C-2... During the investigation, another issue was mentioned to LPA and Ombudsman. Resident (R1) also stated that they are diabetic and staff is "trying to get blood" from him to check his blood sugar, but they are not trained. (R1) stated staff did not test his blood as it's ordered- 3x/day and (R1) "started to refuse". (R1) stated there are (3) staff and one staff is new. The Administrator stated on December 19, 2024 that "staff do not check blood sugar" and (R1) "can't see well" and explained that staff would "set up the test" and (R1) "pokes their finger with the needle" and staff can assist with the test at that point. The Administrator confirmed that (R1) is not on insulin and takes oral tablets. The Administrator stated an on-call Registered Nurse instructed (R1) how to prick their finger and (R1) acknowledged that he understood and was able to demonstrate that they could. Per (R1's) physician's report, (R1) is "not able to perform their own glucose testing (ordered 3x/day) and monitoring and is nearly blind. On March 11, 2025, staff (S1) stated that she did assist (R1) with blood sugar testing but (R1) would refuse to prick themselves on occasion. (S1) stated (R1) asked for guidance, due to not being able to see well, and was able to prick their finger by bringing their finger closer to see. (S1) confirmed she didn't assist (R1) or any other resident with pricking their finger and told (R1) that and she has had training on diabetic care. The Administrator provided detailed information showing when (R1’s) blood sugar was checked each day, commenting "(R1's) blood sugar was in the high hundreds every time". The documentation shows the facility followed the 3x/day order and documented when (R1) refused in the morning on 12/9/24, 12/15/24, 12/16/24, at lunch on 12/18/24, and at breakfast, lunch and dinner on 12/12/24. Based on information obtained, LPA finds this concern to be UNSUBSTANTIATED -meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Exit interview. Copy of report provided to Administrator. 9099C-2.. (S1) stated that the toilet did overflow one time where the water ran on the floor, usually a result of (R1) flushing a lot. (S1) stated she asked (R1) to stop flushing continuously to prevent an overflow. (S1) stated she checks each bathroom in the morning when she checks on the residents. (S1) explained that there were (2) staff here the time the toilet overflowed more onto the floor. (S1) stated they sprayed the floor with chemicals and water to clean the floor and will clean throughout the home, as needed, every day. (2) residents were interviewed and both stated that staff are "always cleaning, including dusting, mopping" and the facility is always clean. LPA observed the facility floors, bathrooms, resident rooms and common areas to be clean on March 11, 2025, on December 19, 2024 and in May 2024 and September 2024 when inspections were also done. Based on information obtained through interviews, the Department finds the allegation to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview. Copy of report provided to Administrator.the state’s words, verbatim · CDSS document, Mar 11, 2025 · control 59-AS-20241218155404

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to complete a case management inspection related to a waiver request submitted to the Department on 12/18/24. LPA met with Balwinder Rai, Administrator, and stated reason for the inspection. During today's inspection, LPA and the Administrator discussed the current residents and their care needs, including if any resident needs a two-person transfer. The Administrator indicated that there are always (2) staff on site at all times to provide care when needed. Also discussed was how the waiver request was submitted, in error, for a resident (R1) who already lives at the facility, and the request should be for a potential resident (R2) who has not moved in yet. LPA obtained an updated waiver request as well as a current physician's report for (R2) noting the diagnoses. LPA confirmed there are currently (4) residents living in the home and (1) resident is expected to return from skilled nursing by end of this month. The waiver is needed since there is currently (1) resident (R1) who is under the age of 60 years. LPA to provide paperwork obtained today to LPM for review. LPA to follow up with Administrator as soon as possible, by tomorrow, 12/20/24, if possible. There are no deficiencies issued in this report. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Dec 19, 2024

Allegation investigated: Licensee does not ensure that residents are provided with quality food while in care. Licensee does not ensure that the facility has enough staff to meet the needs of resident(s) in care. Licensee does not ensure that there is an adequate amount of supplies available to provide care to residents while in care.

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to complete a complaint investigation and deliver findings. LPA met with Balwinder Rai, Administrator, and Gary Rai, manager. Also present was care giver, Veron Reid. LPA observed (2) residents in the common area and (2) residents in their rooms. One resident requested to be sent to the hospital during today's inspection for back pain. During today's inspection, LPA interviewed (2) residents, (1) care staff and (1) family member of a resident. Previously, LPA interviewed (1) caregiver and the Administrator. The facility was toured on 9/17/24 and on 12/2/24 to check for facility supplies, including food. Documentation was reviewed from residents' files including physician's reports, care plans and admission agreements. The results of the investigation are as follows: *cont on 9099C-1.. Unsubstantiated 9099C-1... Allegation: Licensee does not ensure that residents are provided with quality food while in care. The allegation states that residents are given non-nutritional food and food that is poor in quality. LPA observed the food supply on 9/17/24. LPA observed several bags of groceries to be delivered during the inspection which included fresh and frozen vegetables, and other perishables such as yogurt and bread. The Administrator stated that bulk groceries are purchased on Tuesdays and additional groceries on a different day of the week, depending on the facility's needs. The Administrator stated there is currently (1) resident (R1) with diabetes and the resident is offered a low carbohydrate diet as much as possible. Resident's physician's report, dated 8/5/24, notes (R1) has a secondary diagnosis of Type 2 Diabetes; however, does not indicate that (R1) has a special diet. The Administrator stated (R1) is offered sugar-free desserts as well as brown rice, and vegetables are offered at every meal. The Administrator showed LPA photos taken of meals prepared for residents during the month of October. Staff were asked to provide photos of meals served to ensure they are balanced. The Administrator stated she has had no complaints made about the quality of the food from residents or their families. (2) staff were interviewed during the investigation. (1) staff stated on 9/17/24 that the facility has a menu and they "sometimes follow it". This staff stated what was served for breakfast and lunch that day and what was planned for dinner. This staff stated (R1) is not on a special diet, but they try not to give (R1) any spaghetti, caregivers will monitor (R1's) carbohydrates and (R1) will take his blood sugar once daily, before breakfast. A second staff stated on 12/2/24 that there is no "set menu" and residents are asked each day what they would like to eat for each meal, stating "most of the time, residents prefer the same food". This staff stated she doesn't take photos of meals served to residents and stated what will be served for dinner tonight. The Administrator stated staff only took photos of the meals in October 2024 for a month. Both residents interviewed stated they are served fresh food, with a lot of fruits and veggies, and meals are freshly prepared, and the meals are rotated regularly. A family member stated the food seems good, and the facility consistently offers fruit and vegetables with each meal. The Ombudsman conducted a tour on 9/16/24 and did not observe any concerns. Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED -meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. *cont on 9099C-2. *9099C-2... Allegation: Licensee does not ensure that the facility has enough staff to meet the needs of resident(s) in care. The allegation states there is insufficient staffing to provide care to all the residents. One staff stated on 9/17/24 that there is sufficient staffing with (1) staff scheduled per shift, as there are currently (3) residents and no residents who required a two-person transfer. (2) of the (3) residents use a walker and (1) resident is ambulatory. This staff stated NOC staff are "on-call" and will rest in the common area if a resident requests assistance. Another staff stated on 12/2/24 that there are normally (2) staff scheduled, but today the Administrator is covering. This staff stated there are currently not any residents who are two-person transfers. During the NOC shift, there are either 1-2 staff scheduled. Residents (2) stated there are usually (2) staff working on each shift, but sometimes there is (1) if there are less residents. One resident stated she is very independent and doesn't need much assistance, but she sees other residents receive assistance when it's requested. This resident indicated they receive prompt assistance when it's requested with one resident stating she rarely asks for assistance during the NOC shift, but when she does, she is promptly attended to. A family member that visits regularly stated there are 1-2 staff at each time he visits and staffing appears to be sufficient. Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED -meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Allegation: Licensee does not ensure that there is an adequate amount of supplies available to provide care to residents while in care. The allegation states the facility has minimal sheets, towels, disposables, wipes and equipment on hand. LPA toured the facility on 9/17/24 and on 12/2/24 and observed sufficient amounts of sheets, towels, blankets, disposable wipes and Depends (diapers) on hand. Additionally, gloves, sanitizer and PPE supplies were observed. The Ombudsman conducted a tour on 9/16/24 and did not observe any concerns. One staff,who was interviewed on 9/17/24, stated families are asked to provide Depends (diapers) but the facility has an emergency supply if needed. *cont on 9099C-3. 9099C-3... A second staff stated on 12/2/24 that families are only asked to provide wipes, and the facility provides Depends (diapers). This staff stated families are never asked to provide food, as it's freshly prepared on site daily. One resident stated on 12/2/24 that she brought her own hygiene supplies with her. A second resident stated on 12/2/24 that she orders some supplies for herself, but the facility will provide supplies as needed. One family member stated that families are asked to provide Depends (diapers), but he is not asked to bring wipes. The family member stated the facility does not ask that he bring food to his family member. The Administrator stated she always asks residents and their families to provide Depends (diapers) and wipes, but she has back-up supplies, if needed. The Admission Agreement notes that families are asked to provide briefs, wipes, and prescribed ointments and creams. Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED -meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. There are no deficiencies issued. Exit interview. Copy of report provided to the Administrator.the state’s words, verbatim · CDSS document, Dec 2, 2024 · control 59-AS-20240912152448

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a post-licensing inspection. LPA met with Karen Mayers, caregiver, who contacted Administrator, Balwinder Rai, who arrived at 11:30 am. The first resident moved in on/around 5/31/24. A Post-Licensing has not been conducted. LPA and Administrator conducted a tour of the interior of the facility and inspected the physical plant, kitchen, bedrooms, bathrooms, laundry area, and backyard area. LPA observed the facility to be free of odor, clean and in good repair. There is sufficient furniture and lighting throughout the facility. LPA observed required 7 day non-perishable and 2 day perishable food. LPA observed locked medications, knives and toxins to be inaccessible to residents. LPA observed (3) resident files to be organized and complete. LPA observed all required postings to be posted. There are no deficiencies being cited. Exit interview. Copy of report provided to Administrator.the state’s words, verbatim · CDSS document, Sep 17, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Sabrina Calzada arrived announced to conduct a pre-licensing inspection at 2:00 pm on 5/10/24. LPA met with Balwinder Rai, Administrator. There is a pending license for (6) residents, (3) of whom may be bedridden and (3) may be non-ambulatory. There are currently no residents present as this location is not currently licensed. LPA and Administrator toured the interior and exterior of the facility including the common areas, (4) private resident bedrooms (1) shared resident bedroom, (4) resident bathrooms, kitchen, laundry and garage. LPA observed the facility to be clean, in good repair and to have sufficient furniture and lighting throughout. The bathrooms have the necessary grab bars, non-skid flooring, soap, paper towels and 20-second hand-washing poster. LPA observed 7+ day non-perishable food, dishes, flatware and cooking pans in the kitchen. There is an emergency supply of food and water on site. Sharps, toxins and medications are locked in the kitchen. Hot water measured 116*F in the kitchen and the inside temperature measured 72*F. Fire extinguishers were last serviced on 12/21/23 and smoke/monoxide alarms are in working order. The fire door also closes automatically when the alarm is activated. There is a complete First Aid kit on site with additional supplies on hand as well as paper supplies and PPE. LPA observed sufficient linens/towels/blankets. LPA observed various required postings posted, including the Emergency Disaster Plan and Theft & Loss Policy. LPA observed games/activities and an operating land line. All exit doors have alarms. There is patio table with chairs being delivered on 5/14/24. There is one exit gate in the backyard. LPA observed (6) resident binders with dividers and staff folders prepared also. Medication records are electronic but hard copies will be kept also. Administrator certificate #6058964740- exp 3/22/25. Component III was reviewed during today’s inspection. Pre-Licensing is complete and this facility has no deficiencies. Exit interview. Copy of report left at facility. LPA to notify to the Centralized Applications Bureau.the state’s words, verbatim · CDSS document, May 10, 2024

Type of visit: Office

COMP II by CAB successfully completed Method: Phone Call at CAB Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, May 3, 2024