435202608-6-4-2025-26-AS-MPAA-DJWLWF-20250725090703

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202608
Report Date: 06/04/2025
Date Signed: 06/04/2025 04:28:26 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/28/2025 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20250428103647

FACILITY NAME:	DIYA SENIOR CARE CORPORATION		FACILITY NUMBER:	435202608
ADMINISTRATOR:	BHATIA, JASRAJ		FACILITY TYPE:	740
ADDRESS:	366 LASSENPARK CIR		TELEPHONE:	(408) 226-1162
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95136
CAPACITY:	6	CENSUS: 6	DATE:	06/04/2025
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Bani Kaur		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff did not maintain complete records for resident.
Staff did not dispense medication to resident as prescribed.
Staff were unable to effectively communicate with resident due to a language barrier.
Licensee unlawfully evicted resident.
Staff did not ensure resident's dietary needs were met.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Administrator (ADM) Bani Kaur. On 04/28/2025, the department received a complaint with the above allegations. On 05/01/2025, LPA Marrufo conducted an initial complaint investigation visit.

LPA Marrufo obtained a copy of resident R1’s Admission Agreement, which states R1 was admitted to the facility on 10/23/2024.

LPA Marrufo obtained a copy of R1’s Physician’s Report, which has a listed exam date of 02/10/2025 and was signed by the physician on 02/10/2025.

See LIC9099-C pages for more information. Page 1 of 4.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Maria Partoza
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 26-AS-20250428103647

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: DIYA SENIOR CARE CORPORATION	FACILITY NUMBER: 435202608
	VISIT DATE: 06/04/2025

NARRATIVE

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LPA Marrufo obtained copies of emails that Administrator (ADM) Bani Kaur sent to R1’s Case Manager (CM) and Care Team. ADM requested R1’s Physician’s Report from CM in emails dated 10/23/2024, 11/13/2024, and 11/19/2024.

During interview on 05/01/2025, ADM stated that ADM requested R1’s Physician’s Report from R1’s Care Team multiple times. ADM stated R1’s identification and Medicare were not being approved. ADM stated to have told R1’s Care Team that ADM could no longer wait and took R1 to an urgent care clinic to have a Physician’s Report completed.

LPA Marrufo obtained copies of the following emails sent from ADM to R1’s Care Team. On 10/18/2024, ADM emailed R1’s Care Team asking them to ensure that R1 has a 30-day supply of medications. On 11/13/2024, ADM requested R1’s Care Team to provide an update about if R1’s insurance has been updated and that ADM needed R1’s medications refilled as soon as possible. On 02/21/2025, ADM sent an email to R1’s Care Team stating that ADM needed medications for R1.

LPA Marrufo obtained copies of R1’s Medication and Administration Record (MAR) for the months of January to March 2025. R1’s MAR states R1 was administered medication M1 every day in January and February of 2025. R1’s March 2025 MAR has horizontal lines from the dates 03/01/2025 to 03/05/2025 and 03/22/2025 to 03/31/2025. Each day from 03/06/2025 to 03/17/2025 indicates R1 was administered a dosage of M1. The March 2025 MAR indicates R1 was hospitalized from 03/18/2025 to 03/21/2025.

LPA Marrufo obtained a copy of R1’s Centrally Stored Medication and Destruction Record, which records that R1’s M1 medication had a start date of 03/06/2025.

On 05/01/2025, R1 stated during interview that the staff did not understand English. R1 stated the staff’s inability to speak English would result in staff not giving R1 medication according to prescription.

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SUPERVISORS NAME: Maria Partoza
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 26-AS-20250428103647

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: DIYA SENIOR CARE CORPORATION	FACILITY NUMBER: 435202608
	VISIT DATE: 06/04/2025

NARRATIVE

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On 05/01/2025, LPA Marrufo interviewed R2-R6. R2 stated that the staff speak English and R2 can communicate with the staff. R3 stated some of the staff do not speak good enough English and that is why R3 wants to move out of the facility. R3 stated R3’s case worker had to speak to the staff in Spanish about the medications. R4 stated all the staff speak English to some degree. R4 stated staff inability to effectively communicate has led to issues with medications. R5 stated the language barrier of the staff has not been an issue. R6 stated 3 of the staff speak English. R6 stated to have never experienced staff being unable to provide proper care and supervision because they were not able to effectively communicate with residents.

During visit on 05/01/2025, LPA Marrufo interviewed S1 in English and did not have any communication issues with S1.

During visit on 06/04/2025, LPA Marrufo interviewed S2 in English and did not have any communication issues with S2.

R1’s Admission Agreement states R1 was discharged from the facility on 03/18/2025.

On 03/18/2025, the facility submitted an Unusual Incident/Injury Report (IR) to the department. The IR stated that on 03/17/2025, R1 called 911 at around 10:30 PM and requested to be taken to the hospital. R1 was admitted to a hospital and then afterwards was in an emergency psychiatric facility.

On 05/01/2025, LPA Marrufo conducted a telephone interview with R1. R1 stated to have called 911 because “things were getting out of control” and R1 “opted out.” R1 stated that when R1 left the hospital, R1 did not attempt to return to the facility. R1 stated that the facility did not provide R1 with an eviction notice.

During interview on 05/01/2025, ADM stated that R1 called 911 and was taken to an emergency psychiatric facility. ADM stated R1 did not attempt to return to the facility after being discharged from the emergency psychiatric facility.

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SUPERVISORS NAME: Maria Partoza
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 26-AS-20250428103647

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: DIYA SENIOR CARE CORPORATION	FACILITY NUMBER: 435202608
	VISIT DATE: 06/04/2025

NARRATIVE

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On 06/04/2025, LPA Marrufo conducted a telephone interview with R1’s Family Member, FM1, who stated that when R1 left to the hospital, R1 stated to not wish to return to the facility. FM1 also stated to have been told that R1 was not welcomed back in the facility.

R1’s Physician’s Report states R1 has a special diet of low sugar and low fat.

During interview on 05/01/2025, ADM stated that all residents are given a low sugar and low salt diet. ADM stated that some residents still buy soda on their own.

On 05/01/2025, LPA Marrufo interviewed residents R2-R6. R2 stated staff provide R2 with the food that matches R2’s diet. R3 stated to not know if staff give R3 a low-fat diet. R4, R5, and R6 stated to not have a prescribed diet.

On 05/01/2025, LPA Marrufo interviewed staff S1, who stated that when R1 lived at the facility, there was a list of R1’s restricted foods on the facility refrigerator. R1 stated there was a list of R1’s restricted foods above R1’s beds, but R1 tore it off. R1 stated the rule given by ADM to the staff is that food should be no sugar and no salt.

During visit on 05/01/2025, LPA observed residents being served a meal of mashed potatoes and chicken.

On 06/04/2025, LPA Marrufo interviewed S2, who stated to not put any salt or sugar in residents’ meals.

Based on information from interviews conducted with staff, residents, and a witness, and records reviewed, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated.

No Deficiencies were cited under California Code of Regulations Title 22.

This report was reviewed with ADM Bani Kaur and a copy of this report was provided.

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END REPORT

SUPERVISORS NAME: Maria Partoza
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 4