Silver Star

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso, arrived unannounced to conduct a Required -1 Year visit, on 5/13/26 at approximately 9:40am, and met with back-up Administrator, Janine Sorenson. Licensee/Administrator Ami Kumar arrived to meet with the LPA. Facility has an approved dementia plan of operation. There is an approved hospice waiver for three (3) residents. The facility has a required infection control plan. Facility has a required emergency disaster plan. Fire clearance is approved for six (6) non-ambulatory, which includes one(1) bedridden. Emergency disaster quarterly drills are being conducted as required; Last drills were conducted, two shifts on 4/9/26 and one shift on 4/10 26. LPA reviewed six (6) resident files. Medications records were reviewed, and medications were found to be stored as required by regulation/HSC. LPA reviewed five (5) staff files. All staff have criminal record clearance as required. All staff have CPR and first aid certification as required. LPA reviewed required staff training, including medication training for those staff that assist resident's with medications. LPA toured the facility with the Administrator Janine. Hot water was measured at 114.6 degrees Fahrenheit. All exits were free and clear of obstructions. The exit doors had auditory alarms on them. The fire extinguishers were charged as required. The smoke alarms are hard wired and were all working during the inspection. The carbon monoxide detector was working during the inspection. Continued on LIC809C... The facility had a sufficient supply of food. The facility had a sufficient supply of linens, furnishings, cleaners/disinfectants, soaps, hygiene products, paper products, and personal protective equipment (PPE) supplies. All bathrooms had grab bars, and non-slip mats/flooring for resident use. All medications were locked up and inaccessible to residents in care. All disinfectants/cleaners were locked up and inaccessible to residents in care. The facility had sufficient lighting in resident rooms, common areas, bathrooms, and hallways. The facility was clean and orderly. The facility was observed to be at a comfortable temperature. LPA is requesting the following documents be updated and submitted to CCL by 5//13/26: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610 (9 page)- Emergency Disaster Plan- update if needed- submit copy Copy of Current Liability Insurance Copy of Infection Control Plan- update if needed- submit copy LIC400- Affidavit of Client Cash Resources Copy of Bond if handling cash, per LIC400 There are no deficiencies cited during today's inspection. Exit interview was conducted with Administrator Janine Sorenson.the state’s words, verbatim · CDSS document, May 13, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso, arrived unannounced to conducted a Required -1 Year visit, on 4/24/2025, at approximately 9:25am, and met with Licensee/Administrator Ami Kumar, and Janine Sorenson, facility Administrator. Facility has an approved dementia plan of operation. There is an approved hospice waiver for three (3) residents. The facility has a required infection control plan. Facility has a required emergency disaster plan. Fire clearance is approved for six (6) non-ambulatory, which includes one(1) bedridden. LPA reviewed six (6) resident files. LPA reviewed six (6) staff files. LPA reviewed staff training. All staff have criminal record clearance as required. All staff have CPR and first aid certification as required. The LPA toured the facility with Administrator Janine Sorenson. Medications were centrally stored, locked and inaccessible to residents in care, and inaccessible to staff not trained to assist residents' with medications. The hot water was checked at 120. degrees Fahrenheit, which is within regulation. Fire extinguisher, 2 of 2, were serviced and tagged as required. All exits were free and clear of obstructions. Facility was found to be clean, orderly, and at a comfortable temperature. Toxins/cleaners are stored in locked cabinets. All exit alarms were on exit doors and working properly during the inspection. All bathrooms had grab bars, and non-slip mats/flooring for bathing as needed. Required postings were up and visible. LPA observed a sufficient supply of perishable and non-perishable food. Continued on LIC809C... Facility had sufficient supply of emergency food & water meeting the "72 hour shelter in place" requirements. Sufficient supply of hygiene items, cleaners, paper products, and personal protective equipment (PPE) for use as needed. Sufficient supply of linens for resident use. LPA observed various activity items, and equipment for residents in care. The facility had sufficient lighting in resident rooms, bathrooms, hallways, and all common areas for resident use as needed. LPA discussed the Licensee/Administrator Ami Kumar PIN24-09 UPDATED DEMENTIA CARE AND MISCELLANEOUS REGULATIONS FOR RESIDENTIAL CARE FACILITIES FOR THE ELDERLY. LPA advised Licensee/Administrator to print and review the PIN to ensure compliance with regulation changes. LPA is requesting the following documents be updated and submitted to CCL by 5/24//2025: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610 - Emergency Disaster Plan- update if needed- submit if changes Copy of Current Liability Insurance Copy of current Administrator Certificate Copy of updated Infection Control Plan- update if needed- submit if changes LIC400-Affidavit of Client Cash Resources There are no deficiencies cited during today's inspection. Exit interview was conducted with Janine Sorenson, Administrator.the state’s words, verbatim · CDSS document, Apr 24, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an annual required inspection and met with Licensee Ami Kumar and Janine Sorenson, facility Administrator. Facility has an approved dementia plan of operation. There is an approved hospice waiver for three (3) residents. LPA/staff initiated a tour of the facility around 9:00am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Residents rooms were furnished per regulation. Extra hygiene products and linens were available. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality and stored per regulation. Two fire extinguisher was last serviced December 2023. Carbon monoxide and smoke alarms are hard wired with sprinklers and fire door in the hallway were tested and operational at time of inspection. Last Disaster drill was conducted on 4/12/24. Working auditory alarms are placed on all exits and they were operational. Disinfectants and cleaning solutions were stored inaccessible to residents. Required postings were observed. Medications were centrally stored and locked. Hot water temperature reading was 105.3 degrees which is within regulation. LPA initiated file review at 9:30 am. LPA reviewed six residents files and four staff files. All residents files have a current medical assessment and care plans updated within the last 12 months. Staff records have current First Aid/CPR certificates and additional 20 hours of required training. Administrator Certificate for Ami Kumar, 6021684740, expires on 11/8/24. Medications and medication records were reviewed. LPA had a conversation with Licensee regarding start dates should not be written on the prescription label. Licensee agreed to review and update them if needed. Licensee agreed to submit updates of the following documents by 5/27/24: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500) and Copy of Liability Insurance. No deficiencies cited during today's inspection. Exit interview was conducted with Licensee and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 21, 2024