Raksha 6

Type of visit: Required - 1 Year

On 05/26/2026 at 11:30AM, Licensing Program Analyst (LPA) Andrew Christy arrived unannounced to conduct the 1-Year Annual Required inspection. LPA met with Administrator, Nalini Bhutani, and explained the purpose of the visit. The facility is currently at max capacity with six (6) residents. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common area, and backyard. All outdoor and indoor passageways are kept free of obstruction. No bodies of water were observed. A comfortable indoor temperature is maintained at 70.0 degrees Fahrenheit. The hot water temperature in the residents’ shared bathroom was measured at 115.4 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of non-perishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 05/06/2026 with service scheduled in June. At 12:30PM, LPA reviewed five (5) resident files and five (5) residents staff files, all found to be complete. The emergency disaster plan was last reviewed 05/06/2026. Quarterly emergency drills were last conducted 05/06/2026. A review of resident medications and the Medication Administration Record (MAR) found no outstanding errors. No deficiencies cited during visit. Exit interview conducted and a copy of this report was provided to the administrator.the state’s words, verbatim · CDSS document, May 26, 2026

Type of visit: Case Management - Deficiencies

On 08/08/25 at 1:30 PM, LPA L. Holmes conducted a case management visit to discuss the implementation of a fire watch and a plan going forward to bring the facility into compliance. LPA and ADM discussed the details of the fire watch for the addition of a staff room, required requested documents by CCLD, and the results from the fire drill conducted on 08/01/25 at Raksha 4. On 08/01/25, LPA requested the following documentation as soon as possible in addition to the Albany Fire Department requesting a strategy by close of business on 08/01/25; to date the documentation has not been received. 1. Written plan designating one specific staff to perform fire watch around the clock. 2. The names of the staff assigned to such duty. One person or more for each shift, not one person covering the 24-hour shift. 3. The individual designated will perform only fire watch/walk the perimeter looking for fire/fire hazards. The plan should be clear that the fire watch staff on-duty is strictly performing fire watch only NOT in addition to caregiving. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted, Appeal Rights, and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 8, 2025

From the deficiency page — Deficiency type: Type A · Section cited: HSC 87202(a) · Plan of correction due date: Aug 11, 2025

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. -This requirement is not met as evidenced by: Licensee/Administrator did not provide CCLD a proposed strategy while the fire watch was underway and the requested documents to support the fire watch.the state’s words, verbatim · CDSS document, Aug 8, 2025

Plan of correction: 1.Licensee/ED to review regulation 2. provide a written plan designating one specific staff to perform fire watch around the clock 3. Provide the names of the staff assigned to such duty. One person or more for each shift, not one person covering the 24-hour shift. 4.The individual designated will perform only fire watch/walk the perimeter looking for fire/fire hazards. The plan should be clear that the fire watch staff on-duty is strictly performing fire watch only NOT in addition to caregiving.

Type of visit: Required - 1 Year

On 05/06/25 around 01:15 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a required Annual Inspection. LPA was greeted by Nalini Bhutani, Co-Administrator (ADM). The facility’s fire clearance was approved for six (6) non-ambulatory residents; hospice waivers for two (42). LPA requested the resident roster, staff roster, three (3) staff files, three (3) resident files. LPA observed a visitor sign-in log at the entry. Emergency Disaster Plan is posted. LPA and ADM toured the facility, including but not limited to bedrooms, bathroom, kitchen, common area, front yard and backyard. All indoor passageways were free of obstruction. There were not any bodies of water present. Residents were dining for lunch, and watching television. A comfortable temperature for residents was maintained at 72 degrees Fahrenheit (F), and the water temperature measured at 117.8 F. LPA observed lighting in all rooms to be adequate for the comfort and safety of all the residents. The bathrooms were safe, sanitary and in operating condition. Hand washing posters, auto air dryer, and soap observed at hand washing stations. Linen and hygiene supplies were available for all residents. PPE and paper goods remain sufficient. There is a minimum supply of 2-day perishables and 7-days of non-perishable foods. continued on LIC809C... ...continued from LIC809 Smoke detectors/carbon monoxide were in operating condition during visit. Fire extinguisher last serviced on 11/22/24, first aid kit is stored in a locked medication room, and the last emergency disaster drill was conducted on 02/2024 with the fire department; next quarterly drill to include all staff and residents. The following forms are to be updated: -Designation of Administrative Responsibility -Case Management inspection TBD to view detached Staff Room; key is not available during visit. Exit interview conducted and a copy of this report provided to Nalini Bhutani, Co-Administrator.the state’s words, verbatim · CDSS document, May 6, 2025

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 05/29/2024 around 07:45 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a required Annual Inspection. LPA was greeted by Aesha Ahmed, Caregiver (S1) and upon entry and explained the purpose of the visit. The Co-Administrator's Standard Certificate (#6011402740) expires 06/20/25. The facility’s fire clearance was approved for six (6) non-ambulatory residents; hospice waivers for two (2). Shalini Bhutani, Administrator (ADM), arrived about 09:45 AM to sign the report. LPA observed four (4) clients having breakfast and two (2) in their bedrooms, LPA and S1 reviewed the Emergency Disaster Plan, and resident and staff files. LPA observed a visitor sign-in log at the entry. LPA and S1 toured the facility, including but not limited to bedrooms, bathrooms, kitchen, laundry area, common area, front and side yard. The facility consists of five (5) total bedrooms. All indoor passageways were free of obstruction. There weren't any bodies of water. The temperature for the residents was maintained at 79 degrees Fahrenheit (F) and the shared bathroom's water temperature was 107.8 F for the comfort and safety of all the residents. The bathrooms were safe, sanitary and in operating condition. Hand washing posters, paper towels, and soap observed at hand washing stations. Linen and hygiene supplies were available for all residents. PPE and paper goods remain sufficient. There was a minimum supply of 2-day perishables and 7-days of non-perishable foods. continued on LIC809C... ...continued from LIC809 Smoke detectors/carbon monoxide were in operating condition during visit. Fire extinguishers last serviced on 01/22/24, first aid kit observed complete and fire drill was last conducted on 04/012/24. Four (4) staff files reviewed all had criminal record clearance. Four (4) resident files reviewed were complete. The following forms are to be updated: -LIC500 Personnel Report -LIC308 Designation of Administrative Responsibility -LIC610 Emergency Disaster Plan to be updated Exit interview conducted and a copy of this report provided to ADM.the state’s words, verbatim · CDSS document, May 29, 2024

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.