St Michael Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) K. Kaur arrived for an unannounced annual inspection. LPA was allowed entry by staff and met with Licensee Harmesh Kumar and Administrator Sabrina Kaur. LPA toured facility with Licensee and Administrator. All pathways, entrances and exits were clear from obstructions. Common rooms have adequate furnishings and lighting. All of the resident bedrooms have all the required furnishings and adequate lighting. Bathrooms have grab bars/skid mats. LPA observed in room #17, flooring near resident’s bed that is lifting. LPA observed oxygen in use without signage. Several window screens throughout the facility observed to have small tears, Room 15 Bathroom window was missing a screen. Facility refrigerator/freezer temperatures observed with range. LPA observed a 2-day supply of perishable foods. LPA observed a supply of extra bed linens and personal hygiene and grooming products in storage room. Cleaning supplies are stored in a locked closet in the laundry room. Medications are locked in a medication room. First aid kit contains all the required items. A fire extinguisher is present and has a service date of 03/13/2026. Smoke detectors and carbon monoxide were operating. Fire Alarm was inspected by a third party on 04/06/2026. Facility has a call light system, which is operating properly. Outside of the facility toured. No outside hazards were observed. Fire Drill was conducted on 8/10/2026. Resident’s files were reviewed to have signed Admission Agreement, Personal Rights, and Emergency Identifications forms and medical assessments. Staff files reviewed and have the required documentation. Surety bond was reviewed. Liability Insurance policy effective 10/20/25 to 10/20/2026. Medication review conducted revealed two out of four residents’ medication was not administered as prescribed. Deficiencies cited per California Code of Regulations, Title 22, on the attached 809D. LPA requested the following documents to be submitted to CCL by 09/16/2026: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-E), Affidavit regarding Resident Cash Resources (LIC 400), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file. Exit interview completed with Licensee, Harmesh Kumar and Administrator Sabrina Kaur. Plans of corrections were developed by Licensee and reviewed by Administrator and LPA. A copy of this report, deficiencies and appeal rights have been provided to Licensee, whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Sep 9, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87618(b)(3)(B) · Plan of correction due date: Sep 16, 2026

87618 Oxygen Administration - Gas and Liquid (b) In addition to Section 87611(b), the licensee shall be responsible for the following: (3) Ensuring that the use of oxygen equipment meets the following requirements: (B) "No Smoking-Oxygen in Use" signs shall be posted in the appropriate areas. This requirement is not met as evidenced by: Based on observation, interview, and record review, the facility did not comply with the regulation listed above due to R1 not having a "Oxygen in Use Sign" posted, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 9, 2026

Plan of correction: Administrator agrees to have signs posted in appropriate areas. Verification will be sent to the Dept by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(c) · Plan of correction due date: Sep 23, 2026

87303 Maintenance and Operation (c) All window screens shall be clean and maintained in good repair. This requirement is not met as evidenced by: Based on observation, the facility did not comply with the regulation listed above due to several window screens throughout the facility observed to have small tears, Room 15 Bathroom window was missing a screen, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 9, 2026

Plan of correction: Administrator agrees to replace/ repair window screens and submit receipts/ pictures by due date

From the deficiency page — Deficiency type: Type A · Section cited: HSC 87465(a)(4) · Plan of correction due date: Sep 10, 2026

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on observation, interview, and record review two out of four residents’ medication was not administered as prescribed. R2’s Docusate 100 MG started on 8/17/2026 to 9/9/2026 should have 24 pills given from Qty 30. Bubble pack has 4 remaining, which means 26 were given. R3’s Trazodone HCL 50 has a start of 8/31/2026 for PRN and routine medication. 08/31/2026 – 9/9/2026 should have 10 given for routine and PRN log shows 6 pills given total of 16. Qty 60 – 16 = 44 should be remaining and bubble pack has 47 remaining which poses an Immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 9, 2026

Plan of correction: Administrator agrees to submit statement of intent by due date to review process to implement to avoid future error and provide in-service training to staff and submit records when completed.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: Sep 23, 2026

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation, and interview, the facility did not comply with the regulation listed above due to Room 18 observed with sink faucet that splashes water outside of the sink, Room 17 has flooring that is lifted, transition strip missing in common room which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 9, 2026

Plan of correction: Administrator agrees to repair and submit invoices, receipts, and pictures of repairs by due date.

Allegation investigated: Staff do not ensure the residents are provided nutritious meals Staff yell at residents Staff do not ensure resident is provided with a comfortable mattress

Licensing Program Analyst (LPA) K. Kaur arrived at the facility for subsequent complaint inspection. LPA met with Administrator Sabrina Kaur and explained the purpose of the visit and reviewed the elements of the allegations. LPA delivered the following complaint investigation findings. The Department investigated the allegations listed above. Based on interviews conducted with Residents and staff no incident was witnessed of staff yelling at residents. Based on observations resident meals and mattress meet licensing requirements. Based on these findings, the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore these allegations are unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, May 28, 2026 · control 24-AS-20260217102739

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff did not maintain a comfortable temperature for residents in care.

On May 6, 2026 Licensing Program Analyst (LPA) B. Miranda and Licensing Program Manager (LPM) A. Walton arrived at the facility unannounced to deliver findings for the allegation listed above. LPA & LPM met with Administrator Harmesh Kumar. Regarding the allegation: Staff did not maintain a comfortable temperature for residents in care. The Dept conducted multiple interviews and observed thermostats in the facility. During today's visit LPA & LPM observed the thermostats to be at 72 degrees Fahrenheit. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted, and a of this report LIC9099 was provided to Administrator Harmesh Kumar. Unsubstantiatedthe state’s words, verbatim · CDSS document, May 6, 2026 · control 24-AS-20260324170734

Allegation investigated: Staff made an inappropriate comment to a resident in care.

On May 6, 2026 Licensing Program Analyst (LPA) B. Miranda and Licensing Program Manager (LPM) A. Walton arrived at the facility unannounced to deliver findings for the allegation listed above. LPA & LPM met with Administrator Harmesh Kumar. Regarding the allegation: Staff made an inappropriate comment to a resident in care. The Dept conducted multiple interviews and was informed staff make inappropriate comments to residents in care. Based on interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8, Article 8, is being cited on the attached LIC 9099D. Exit interview was conducted, and a of this report LIC9099, LIC9099D, and appeal rights were provided to Administrator Harmesh Kumar. Substantiatedthe state’s words, verbatim · CDSS document, May 6, 2026 · control 24-AS-20260324170734

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: May 15, 2026

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on observation & interview, the facility did not comply with the regulation listed above due to multiple interviewees stating staff inappropriately speak to residents in care, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 6, 2026

Plan of correction: Licensee will conduct staff training on Personal Rights and Mandated Reporting. Verification of training and staff attendance will be provided to the Dept by POC due date.

Type of visit: Case Management - Health Checks

LPA L. Xiong was at the above facility for a case management health checks. A tour of the facility was conducted. Residents observed and spoke to all indicated they were doing good and like their breakfast. The residents relocated from Autumn Oaks were observed to be adjusting well to their new home.the state’s words, verbatim · CDSS document, Oct 31, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Shawna Doucette arrived to the facility announced to conduct the Pre licensing visit. LPA Shawna Doucette met with Licensee/Administrator Harmesh Kumar who granted LPA's entry into the facility. LPA toured facility. Common rooms have adequate furnishings and lighting. All of the resident bedrooms have all the required furnishings and adequate lighting. Sample of bathrooms were checked and hot water temperature in bathrooms measured between 110 F to 117 degrees F. Bathrooms have grab bars/skid mats. LPA observed a supply of extra bed linens and personal hygiene and grooming products. Facility has refrigerator/freezer. Cleaning supplies are stored in a locked closet in the laundry room. Medications are locked in a medication room. First aid kit contains all the required items. A fire extinguisher is present and has a service date of 03/12/2025. Smoke detectors and carbon monoxide were operating. Facility has a call light system, which is operating properly. Outside of the facility toured. Exits open free of obstruction. No outside hazards were observed. No pools or bodies of water. Facility phone number will be (559) 607-1920. LPA reviewed Comp III with Licensee. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 26, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Shawna Doucette arrived to the facility announced to conduct the Pre licensing visit. LPA Shawna Doucette met with Licensee/Administrator Harmesh Kumar who granted LPA's entry into the facility. LPA toured facility. Common rooms have adequate furnishings and lighting. All of the resident bedrooms have all the required furnishings and adequate lighting. Sample of bathrooms were checked and hot water temperature in bathrooms measured between 89.2 F to 124.1 degrees F. Bathroom is missing shower grab bar. LPA observed a supply of extra bed linens and personal hygiene and grooming products. Kitchen is missing the refrigerator. Cleaning supplies are stored in a locked closet in the laundry room. Medications are locked in a medication room. First aid kit contains all the required items. A fire extinguisher is present and has a service date of 03/12/2025. Smoke detectors and carbon monoxide were operating. Facility has a call light system. System needs to identify the room when call light is pulled. Outside of the facility toured. Exits open free of obstruction. No outside hazards were observed. No pools or bodies of water. Facility phone number will be (559) 607-1920. LPA will return at a later date once corrections are completed. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 15, 2025

The state marks this report as 6 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Office

Facility Type: Residential Care Facility for the Elderly Application Type: Initial Capacity: 49 Census (if any clients in care): 0 COMP II Participants: HARMESH KUMAR Interview Method: Telephone interview On June 12, 2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jun 12, 2025