Sacred Hands Living

Allegation investigated: Staff did not seek medical attention for resident in a timely manner. Staff did not notify resident's responsible party of incident.

On 05/05/2026 at 1:42PM, Licensing Program Analysts (LPA), T. Syess-Gibson arrived unannounced to deliver complaint findings for the allegations above. LPA met with Caregiver, Charmaine Walters Givans, and explained the reason for the visit. Licensee/Administrator, Rajwant Panesar arrived at 2:08PM. During the course of the investigation, the Department conducted interviews with staff, residents, witnesses, and the complainant. The Department also reviewed various records related to Resident (R1), including but not limited R1’s pre appraisal agreement, identification and emergency information, admission agreement, physician's report and Needs/Services plan, showering/bathing/changing diapers’ schedules, level of care notes / functional assessments and special incident reports. Additionally, medical records from the hospital were obtained and reviewed. The facility's client roster and staff schedule were also collected and examined. Continue on LIC9099C... Substantiated Continued from LIC9099 Staff did not seek medical attention for resident in a timely manner. During the Department’s interview on 11/13/2025, W1 stated that on 8/4/2025, W1 went to the facility to drop off supplies. S2 reported to W1 that there was something wrong with R1’s foot. W1 examined R1’s foot and noticed something was wrong with R1’s left leg. R1 was transported to the hospital the same day. On 9/10/2025, the Department obtained a copy of R1’s medical record from 8/4/2025 that indicated R1 received x-rays to R1’s left foot, ankle, knee and hip. Radiology imaging showed a left distal femur fracture. R1’s orthopedic progress notes dated 8/5/2025 indicated “interval healing/callus formation suggesting at least 6+ weeks of healing”. The Department interviewed S1 on 11/26/2025, and S1 denied R1 having any falls while at the facility. S1 stated R1’s legs and knees always looked distorted, because R1 had arthritis. S1 added R1’s legs were never straight and S1 did not see anything abnormal with R1’s legs. According to S1, staff did not report to S1 of any falls. However, S1 believed that the injury occurred when “R1 would get R1’s leg on the side of the bed rail and got twisted the wrong way”. Staff did not notify resident's responsible party of incident. Interview with W1 revealed facility did not notify W1 of R1’s leg injury timely, W1 was informed by physician of R1's leg being injured for approximately 6-8 weeks upon admission to the hospital. Interview with S1 revealed, R1's leg was never straight and S1 believed R1’s diagnoses or caused the leg to get worst. Interview with S1 also revealed that S1 did not see a need to notify the R1’s responsible party of R1’s leg being worst. Record review revealed facility did not update R1’s appraisal needs and service plan with the change of condition and provide a copy to R1's responsible party. Continue on LIC9099C... Continued from LIC9099 Resident fell resulting in fracture. During an interview with W1 on 11/20/2025, W2 on 08/25/2025, S1 on 11/26/2025, S2 on 11/26/2025, and S3 on 11/21/2025, interviews revealed that R1 has not had any witnessed falls and does not have any knowledge of R1 falling. During Interview with S1 on 11/26/2025, S1 stated she believes the injury occurred when R1 would put her leg on the side of the bed rail and got twisted the wrong way. During record review of R1’s physician's report dated 09/04/2024, it was noted R1 with a diagnosis of dementia. According to R1’s Appraisal Needs and Service Plan, R1 requires assistance with ADLS and is able to pivot from side to side when transferring from bed to wheelchair. R1’s medical record indicates that R1 was admitted to the hospital on 08/04/2025 due to foot pain. R1 was discharged on 08/09/2025, with a diagnosis of a left distal femur fracture and interval healing/callus formation suggested at least six (6+) plus weeks of healing. Medical records does not reveal injury is a result of R1 falling. Staff left resident soiled for an extended period of time. Interview with W1 revealed R1 was observed being soiled during a visit in January 2023. Interview with W1 also revealed that W1 has not observed R1 being soiled since the incident in January 2023. Interviews with S1 and S2 revealed staff changes incontinence residents every two hours, between meals, and as needed when staff has observed residents are soiled. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted. A copy of this report and appeal rights provided. Exit interview conducted and a copy of this report was provided. Continued from LIC9099C Based on the Department’s investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. Health and Safety Code are being cited on the attached LIC809D. A $500.00 immediate civil penalty is being assessed on this day. Civil penalty determination related to serious bodily injury is pending. A formal conference with CCLD will be scheduled at a later time. Exit interview conducted. A copy of this report, LIC421IM, and appeal rights were provided to Rajwant Panesar.the state’s words, verbatim · CDSS document, May 5, 2026 · control 15-AS-20250808150541

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(g) · Plan of correction due date: May 6, 2026

87465(g) Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement is not met as evidenced by: Based on investigation, licensee did not comply with the section cited above by failing to contact 911 medical attention for R1's left femur fracture injury which posed an immediate health and safety risk to the persons in care.the state’s words, verbatim · CDSS document, May 5, 2026

Plan of correction: By POC date, Licensee agreed to implement a plan on emergency response protocols, specifically when it is required to immediately contact 9-1-1. Licensee will also provide training to all staff from an authorized vendor regarding emergency response procedures, including specific criteria for contacting 9-1-1. Facility will submit the new plan and in-service date to CCLD. Immediate $500 Civil Penalty is being assessed.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: May 12, 2026

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence.... This requirement is not met as evidenced by Based on interview, observation, and record review, the licensee did not comply with the section above by not reporting R1’s incidents to CCL and the person responsible for R1 which posed a health, safety and personal rights risk to the persons in care.the state’s words, verbatim · CDSS document, May 5, 2026

Plan of correction: By POC date, Licensee agreed to obtain training for all staff on reporting requirements from an authorized vendor and submit certifications to CCLD.

Type of visit: Case Management - Deficiencies

On 05/05/2026 at 3:10PM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct a case management visit. LPA met with Licensee/Administrator, Rajwant Panesar and explained the purpose for the visit. During complaint investigation (#15-AS-20250808150541), The following deficiency was observed. LPA T. Syess-Gibson observed facility did not report any incidents pertaining to resident (R1) to CCLD as per regulation reporting requirements. LPA already cited (87211 (a) (1)) on complaint number (15-AS-20250808150541) Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D on complaint number (15-AS-20250808150541). 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, May 5, 2026

Type of visit: Required - 1 Year

On 01/14/26 at 2:10 pm Licensing Program Analysts (LPA) J. Clancy-Czuleger arrived unannounced to do an annual inspection. LPA meet with Rajwant Panesar, Licensee and explained the purpose of the visit. LPA inspected the facility inside out. There is no body of water. Physical plant is consistent with the facility sketch received by Central Application Bureau (CAB) and approved by the fire department. LPA inspected the living room, dining area, kitchen, bedrooms, hallways, bathrooms, side and backyards. Bedrooms were observed appropriately furnished with adequate lighting and drawers. Facility has sufficient towels, extra bed sheets and comforters. Equipment and supplies for residents' personal hygiene are available and on site. Dinner and silver wares were observed sufficient for residents' use. Food supplies checked and observed good for seven days of non-perishables. Facility was observed equipped with refrigerator, microwave, dishwasher, washer and dryer. Cabinet for knives, cleaning supplies, and central storage for medications were observed with locks. Activity supplies were available. Outdoor activity space was observed furnished with tables, chairs and shade. The facility has a mitigation plan. Fire extinguishers were observed fully charge and tags showed serviced 08/06/2025. The following deficiency was observed: LPA found three expired cans of food and two expired bottles of juice The Facility was cited, and citations can be found on the LIC 809-D. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 14, 2026

Allegation investigated: Staff poured hot water on resident causing injuries.

On 12/03/2025 AT 1:03PM, Licensing Program Analyst (LPA), T. Syess-Gibson arrived unannounced to deliver the findings of the above allegation. LPA met with Charmaine Walters-Givens, Caregiver, and explained the purpose of the visit. Rajwant, Administer arrived at approximately 1:30PM. During the course of the investigation, the department obtained medical records, letter of agreement (LOA), Staff daily notes, resident (R1) emergency contact information, and incident reports. The department interviewed resident(R1), staff (S1, S2), and R1’s case manager (CM). Continue on LIC9099C... Unsubstantiated Continued from LIC9099 Allegation: Staff poured hot water on resident causing injuries. During the investigation interviews with S1, S2 and CM revealed, R1 was having problems with his ear, facility staff called paramedics and R1 was transported to hospital. R1 never mentioned anything about staff member pouring hot water on him and R1 has a history of making up stories that aren't true. Interview with R1 revealed, R1 was transported to hospital for ear problem. R1 also stated during interview of not reporting the hot water incident to staff, CM, paramedics or medical personnel during R1’s hospital visit. Records review revealed R1 was admitted to John Muir Health on June 19, 2025, due to a recent fall, medical records do not indicate anything related to a burn. Record review also revealed, R1 did not return to the facility after hospital visit. Based upon the information obtained and the interviews conducted during investigation. The above allegation is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and a copy of report was given to Rajwant Panesar.the state’s words, verbatim · CDSS document, Dec 3, 2025 · control 15-AS-20250805163446

Type of visit: Case Management - Health Checks

On 08/12/205 at 11:30AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced Health and Safety check due to the department receiving a priority 1 complaint. During the health and safety check, LPA observed a total of 2 staff members and 4 residents at the facility. LPA toured facility with administrator, including but not limited to bedrooms, kitchen, bathroom, garage and common areas. Residents in care appear to be safe and there are no imminent health/safety concerns on today's date. LPA observed the following deficiencies: At 11:00AM, LPA observed two flip locks on the inside of the main entry door, one(1) at the top and one(1) at the bottom At 11:09AM, LPA observed R1’s records were not at the facility Continued on LIC809C Continued from LIC809 At 11:36AM, LPA observed a bedroom for staff inside of the first garage At 11:40AM, LPA observed walkers, chairs, mattresses and boxes obstructing the pathway in second garage At 12:01PM, LPA observed kitchen pantry locked with non perishable foods Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. **The total amount of civil penalties assessed on today's date is $500.00 for repeated violations.** Exit interview conducted. A copy of appeal rights, LIC421FC and this report provided.the state’s words, verbatim · CDSS document, Aug 12, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(6) · Plan of correction due date: Aug 19, 2025

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(6)To leave or depart the facility at any time....This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in having an additional flip lock on front door which posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 12, 2025

Plan of correction: Administrator removed additional flip lock from front door. Deficiency cleared during visit

From the deficiency page — Deficiency type: Type B · Section cited: CCR87506(d) · Plan of correction due date: Aug 19, 2025

(d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours....This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in not having R1’s records available for licensing agency to inspect which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 12, 2025

Plan of correction: Administrator agreed to read regulation 87506(d) and send a email of a plan to assure all residents files will be available for licensing agency to inspect... by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87305(b) · Plan of correction due date: Aug 19, 2025

(b)The licensing agency may require the facility to acquire a local building inspection where the agency determines..... This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above in obtaining a building permit or contacting CCLD prior to construction which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 12, 2025

Plan of correction: Administrator agreed to submit an LIC200 and updated facility sketch to CCLD by POC date

From the deficiency page — Deficiency type: Type B · Section cited: CCR87307(d)(6) · Plan of correction due date: Aug 19, 2025

(d) The following space and safety provisions shall apply to all facilities:(6)All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in having mattresses, walkers, chairs and boxes in the garage obstructing passageway which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 12, 2025

Plan of correction: Administrator agreed to clean garage, remove items and send CCLD a phot email by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Aug 19, 2025

(a)Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3)To be free from punishment, humiliation, intimidation, abuse... This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in having kitchen pantry with non perishable foods locked which poses a personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 12, 2025

Plan of correction: Administrator agreed to replace key entry door knob with a keyless door knob and send CCLD photo email by POC date.

Type of visit: Required - 1 Year

On 01/14/2025 at 8:50AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced 1-Year Required inspection. LPA met with Caregiver Charmaine Walters Givans, spoke with Administrator, Rajwant K. Panesar via telephone, and explained the purpose of the visit. Administrator arrived at 10:00AM and currently holds a certificate (#7014378740) that expires on 12/18/2025 per CDSS portal. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of six (6) bedrooms and three (3) bathrooms. All outdoor and indoor passageways are kept free of obstruction. LPA did not observe any bodies of water. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 100.6 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last purchased on 07/22/2024. Emergency Disaster Plan was last posted on 12/2024. First aid kit was observed to be complete. Fire drill was last conducted on 12/29/2024. Continued on LIC809C. Continued from LIC809. Four (4) staff records were reviewed, all staff records were complete. LPA reviewed five (5) resident records, and they were current and complete. LPA reviewed a sample of medication during visit. LPA requested the following documents to be submitted to CCLD by 01/21/2025. · LIC 308 Designation of Administrative Responsibility · LIC 309 Administrative Organization · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan (last page) · Liability Insurance LPA observed the following deficiencies during visit: At: 9:15AM, LPA observed personnel and residents' files weren't available at facility for licensing to inspect. At 10:00AM, LPA observed during facility tour the single car garage has been converted into staff bedroom with a bed, suitcases, sofa, laundry detergent and hygiene products. At 10:15AM, LPA observed during facility tour a locked pantry door in kitchen with food, knives(sharps), and medications. At 10:21AM, LPA observed during tour facility side gate were locked. Staff removed lock during inspection. Civil penalty of $500 is being assessed. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in Civil Penalties. Exit interview conducted a copy of this report, LIC421IM, and appeal rights provided.the state’s words, verbatim · CDSS document, Jan 14, 2025