Nestcare Assisted Living

Type of visit: Prelicensing

On 6/5/2026 at 9:00am Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an announced Pre-Licensing Inspection at the facility. Upon arrival LPA met with the Administrator Sherwood Dustina, introduced herself, showing the department badge and conducted an entrance interview. Fire Clearance was approved on 4/27/2026 for a maximum capacity of six (6) residents, of which six (6) may be non-ambulatory, facility does not have approval for bedridden residents. This is a single-story house with four (4) bedrooms and two (2) bathrooms. All four bedrooms are designated for residents’ use. Facility will have an awake night shift staff on premises. At 9:45 am a physical plant was toured inside and out of the property with the assistance of the Administrator and the following was observed: KITCHEN: The facility has an open kitchen area that is equipped with a new refrigerator, microwave oven and sink. At 9:55am, LPA observed adequate supplies of nonperishable food properly stored in the cabinets. Perishable food items are not required at this time as there are no residents in the facility. LPA observed dining ware to accommodate a maximum capacity of six (6) residents. All knives and sharps are observed to be locked inside a kitchen cabinet and inaccessible to residents in care. The facility has one (1) new fire extinguisher which was purchased on 6/5/2026. Continue on LIC809-C Laundry Area: A functioning washer and dryer are located inside the garage. Disinfectants, laundry detergents, and hygiene supplies will be stored securely in a garage as well. COMMON AREAS: At 10:20am LPA observed the living/family room and dining room furniture to be clean and in good repair. The facility maintains a comfortable temperature at 70°F. The air conditioner is operational. No firearms observed or will be maintained on the premises. Licensee has ordered puzzles, books, balls, and board games to provide activities to clients in care. No obstructions and or tripping hazards observed throughout the facility. Bedrooms: There are four (4) bedrooms in the facility. Bedrooms are furnished and well equipped with beds, nightstands, chairs, dresser, bedding, pillowcase, mattress pad, and blankets; extra linen is available inside each bedroom closet. Rooms were observed to have sufficient lighting and closet space. LPA observed appropriate window screens. Sufficient supplies of personal hygiene products stored in the storage area and will be provided to the clients by the Licensee. Facility will have an awake staff. BATHROOMS: The facility has two (2) bathrooms, all bathrooms are designated for residents’ and staff use. Bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 11:05am to be 117.4F degrees. SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. At 11:05am they were tested and observed to be operational. Facility has phone which was checked to be operational. Medications: LPA observed medications will be kept centrally stored and locked inside the hallway closet. The key cannot be accessible to residents in care. Clients and staff files will be kept inside the commercial locket cabinet located in the hallway. Continue on LIC809-C SURROUNDING GROUNDS: The facility has sufficient yard space. LPA observed the backyard with appropriate outdoor furniture and covered shaded areas for clients. LPA discussed the importance of maintaining care and supervision to meet the needs of clients. During the physical walk through LPA observed all exit areas to be free of clutter and obstruction. There is no water in the promises. GARAGE: LPA observed that laundry machines are installed inside the garage, which will also be used for storage. An additional refrigerator is present as well. Component III was conducted with the Licensee/Administrator. Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and will be notified by the CAB Analyst when the license has been approved. LPA collected copy of the Administrator Certificate – Exp date: 7/7/2026. LPA also informed Administrator to update the new form of the Emergency Disaster Plan and submit it to the department. Exit interview was conducted, a copy of this report signed and delivered to the Administrator.the state’s words, verbatim · CDSS document, Jun 5, 2026

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 06 Census : 0 Method: Telephone call with CAB COMP II Participants: SANASAR GRBASHYAN Administrator/Licensee participated in COMP II via telephone call with CAB analyst. Identification of the Administrator/Licensee was verified by confirming driver’s license number. During COMP II, Administrator/Licensee confirmed the understanding of Title 22. Component II was successfully completed. Administrator/Licensee was advised to email signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Administrator/Licensee's understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, May 14, 2026