Post-licensing visit·February 19, 2026

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a Post Licensing visit. LPA met with and was greeted by Rajesh Kalra, licensee. Facility currently has seven (7) residents in care one (1) of which is currently on hospice. LPA and licensee toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Some food was found open and unsealed or missing date of opening. LPA discussed with kitchen staff and licensee ensuring all foods, especially sugar and other staples to be properly sealed. LPA observed kitchen cabinet under sink to contain disinfectants and cleaning supplies. Cabinet has locking mechanism. LPA discussed with licensee ensuring that all disinfectants remain locked at all times. LPA discussed with licensee and kitchen staff importance of maintaining accurate and up to date temperature logs on the both the refrigerator and freezer. All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Resident bathrooms had required bath mats and grab bars. LPA observed pull cords present in toured rooms and bathrooms. LPA tested pull cord and observed caregivers notification alert. As of now, residents do not have pendants. LPA discussed regulation 87303 which states: Facilities shall have signal systems which shall meet the following criteria: (1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall: (A) Operate from each Continued on 809C... Continued form 809... resident's living unit. (B) Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. (C) Identify the specific resident living unit. Water temperature in sinks measured at 107.8 degrees F in the kitchen and 105.4 in the community bathroom, and 114.7 degrees F in room #111, all of which are within the allowable range of 105 to 120 degrees F. Facility has another room designated staff break room. LPA conducted a review staff records. Staff mostly have training completed. Per licensee, staff that have not completed training are on not active on the floor yet. LPA discussed with licensee ensuring all training is conducted per Health and Safety Code (HSC) 1569.625 and 1569.69. LPA also discussed with licensee that First Aid is required of all staff and that at least one staff member per shift has CPR certification. However, it may be beneficial to have all staff complete CPR/First Aid in case of scheduling changes, etc. LPA discussed with licensee importance of having all staff complete a Health Screen with TB clearance before working with residents. LPA conducted a review of resident files. LPA discussed with licensee ensuring all orders for half rails are on file. LPA and licensee conducted a spot check of medication and medication records. Medication is centrally stored in a locked cart. LPA discussed with licensee and Health and Wellness Director (HWD) the requirement of PRN MARs, having current signed doctor's orders on file, and the maintenance of Centrally Stored Medication Log (CSML). All current doctors orders, including those orders from hospice, and PRNs must be on the CSML. Additionally, if a medication is discontinued a discontinuation order must be maintained in the resident's file. No deficiencies cited during this inspection. Exit interview conducted with licensee and a copy of this report was given.