Guardian Senior Home on Nevada

Type of visit: Annual/Random

On August 28, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Administrator (AD) Evan Tran was notified via telephone and later arrived to assist with the inspection. LPA observed that Evan Tran has a valid Administrator certificate which expires on January 2, 2028. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has an approved hospice waiver for six residents. The facility is a single story home which consist of four resident bedrooms, two of which are shared, one staff bedroom, three bathrooms, a living room, a dining room, a kitchen, an atrium, and an attached two car garage. LPA, accompanied by the AD, conducted a tour of the interior portions of the facility. On today's visit, LPA observed six resident and three care giving staff present. LPA observed the See Something, Say Something poster, (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected all four resident bedrooms and observed them to be free of hazards. LPA observed resident bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed additional linens to be stored in a hallway closet. LPA inspected the three resident bathroom and observed it to be clean. Bathroom were equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. The hot water temperature measured between 114.9 and 118.7 degrees Fahrenheit. LPA observed the one staff bedrooms to be kept locked and inaccessible to residents in care. LPA observed the facility has a two day perishable and a seven day non-perishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. CONTINUED ON LIC809-C LPA observed chemicals and toxins to be stored in a locked kitchen cabinet under the sink. LPA observed fire extinguishers to be mounted on the wall in the kitchen and in the two car garage. Fire extinguishers were observed to be charged and serviced on December 3, 2025. LPA observed the centrally stored medication to also be kept in a locked closet located in the resident hallway. LPA observed the facility has a first aid kit stored in the same closet and it had all the required components. LPA tested the wired smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility conducted their most recent emergency disaster drill on June 26, 2026. LPA observed the door leading to the attached two car garage to be kept locked and inaccessible to residents in care. LPA observed the garage to be used for storage and laundry. LPA also observed the facility has a three day emergency food and water supply stored in the garage. LPA, accompanied by the AD, conducted a tour of the exterior portions of the facility. LPA observed the exterior to be free of any obstruction or hazards. LPA observed a shaded outdoor seating area with furniture for resident use. LPA observed the perimeter gate of the facility to be self latching can be opened in an evacuation. There are no bodies of water on the premises. LPA reviewed all six resident files. LPA observed that the Reappraisals on file for Resident #1 (R1) and Resident #5 (R5) were outdated, since they were not updated within the last twelve months. The most recent Reappraisal on file for R1 was completed on September 28, 2023. The most recent Reappraisal on file for R5 was completed on March 18, 2024. LPA also observed that the facility did not have a Reappraisal on file for Resident #3 (R3). LPA reviewed the residents' medication and medication records. LPA reviewed six staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, a deficiency is being cited on the attached LIC809-D page. An exit interview was conducted with Administrator Evan Tran. A copy of the report and appeal rights were provided at time of visit.the state’s words, verbatim · CDSS document, Aug 28, 2026

Type of visit: Required - 1 Year

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 6 residents and the home currently has 3 residents. Administrator (AD) Evan Tran arrived shortly to help conduct visit. AD provided updated liability insurance that expires on 09/17/2025. LPA along with staff toured the facility at 1:45 PM. LPA toured the physical plant, checked food service, and facility documentation. The home consists of 4 resident bedrooms, staff room, living room, dining room, and kitchen as well as 3 bathrooms. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 108.5 degrees F and 111.3 degrees F in all bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarms were operational during today's visit. LPA toured the kitchen and observed sharps locked in a cabinet during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility last conducted a quarterly emergency drill on 03/01/2025. Outside grounds were toured. Walkways around the home were clear of hazards. There is shaded outdoor seating for residents. Exit gate is unlocked and operational. LPA observed the emergency food and water supply. LPA reviewed three resident files and four staff files. Continued on LIC809C dated 08/01/2025 All resident files contained required documentation including admission agreements, physician reports, resident appraisals, and physician orders for bed rails as indicated. Staff files reviewed contained documentation including, medical assessment/ TB, criminal record clearance and proof of CPR training. There was no formal annual training documented for four out of four staff within the last 12 months. LPA reviewed medication storage and administration. Medications are stored in a locked closet. Based on the observations made during today’s visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided along with appeal rights.the state’s words, verbatim · CDSS document, Aug 1, 2025

The state marks this report as 8 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

On 11/19/2024, LPA Mason arrived at the facility for the purpose of updated the LIC809D page issued to the facility on 9/20/2024 as part of the Department's investigation into complaint #22-AS-20240920154018. LPA was greeted and granted entry into facility by Liza Moreno, Caregiver. LPA explained the purpose of the visit. LPA amended the LIC809D page to remove the citation regarding reporting requirements. LPA explained to the facility staff that, the deficiency will remain attached to the Case Management visit conducted on 10/30/2024. LPA also explained that, the facility fulfilled the plan of corrections for the citation issued on 10/30/2024 and that no further action was required from the facility regarding that citation. LPA reviewed this report with facility staff and provided a copy to the report as well as the amended LIC809D page.the state’s words, verbatim · CDSS document, Nov 19, 2024

Type of visit: Case Management - Deficiencies

On 10/30/2024, LPA Mason arrived at the facility unannounced for the purpose of issuing a citation based on observations made during a complaint investigation. During the investigation, it was determined that the facility did not file incident reports for instances of residents engaging in aggressive behavior toward staff. LPA advised facility staff of reporting requirements. Based on today's inspection, one citation is being issued. The facility fulfilled the plan of correction on 10/21/2024. LPA reviewed this report with facility staff. A copy of this report and plan of correction clear letter were provided to the facility.the state’s words, verbatim · CDSS document, Oct 30, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Oct 31, 2024

87211(A)(1)(D) REPORTING REQUIREMENTS (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of...(D) Any incident which threatens the welfare, safety or health of any resident. Based on interviews conducted and records reviewed, the licensee did not comply with the above regulation due to the facility not reporting aggressive acts to staff by a resident.the state’s words, verbatim · CDSS document, Oct 30, 2024

Plan of correction: Adminsitrator stated they will conduct an in-service training with all staff regarding eviction procedures. AD stated they will document the topics covered, staff in attendance and date/time of the training. AD stated they will email LPA documentation related to training by the POC due date.

Allegation investigated: Facility issued residents an unlawful eviction

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Dwayne Mason Jr. for the purpose of concluding the investigation into the above-mentioned complaint allegation. LPA met with Caregiver (Lisa Moreno). LPA spoke with Administrator (AD) Evan Tran over the phone and discussed the purpose of the inspection. On 9/20/2024, the Department received a complaint stated the Facility issued residents an unlawful eviction. On 9/23/2024 the Department conducted a case management visit to the facility and confirmed R1 underwent a medical and behavioral episode which led to high blood pressure in R1 and resulted in R1 hitting a staff member. On 9/23/2024, the Department received an email from the facility including the notice of the plan to evict. LPA obtained screenshots of the eviction notice issued to R1's responsible person. LPA noted that the notice was sent to the RP on 9/20/2024. LPA determined facility issued an unlawful eviction. (continued on LIC9099-C) Substantiated (continued from LIC9099) On 9/30/2024, LPA conducted a visit to the facility. LPA conducted interviews with AD and staff. The AD and Staff stated R1 and R2 were verbally and physically aggressive toward staff members on multiple occasions. LPA obtained audio and video recordings of R1 and R2's behavior. Based on interviews conducted and records reviewed, LPA determined the facility did not report any of the aggressive acts to staff that occurred from R1 and R2. A deficiency is being issued. LPA also reviewed the reporting requirements as stated in Component III with the facility staff and provided an electronic copy of the presentation. Based on interviews conducted and records reviewed, LPA determined that due the facility issuing a same-day eviction notice to R1 without approval from the Department, the facility issued an unlawful eviction. Therefore, there is a preponderance of evidence to support the allegation of Facility issued resident an unlawful eviction. The preponderance of evidence standard has been met. The allegation of Facility issued residents an unlawful eviction is determined to be SUBSTANTIATED, meaning the complaint allegation is valid and that a violation has occurred. An exit interview was conducted, and this report was reviewed with facility staff. A copy of this LIC-9099, deficiency page and appeal rights were provided to the facility.the state’s words, verbatim · CDSS document, Oct 15, 2024 · control 22-AS-20240920154018

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(b) · Plan of correction due date: Oct 25, 2024

87224(b) EVICTION PROCEDURES (b) The licensee may, upon obtaining prior written approval from the licensing agency, evict the resident upon three (3) days written notice to quit. The licensing agency may grant approval for the eviction upon a finding of good cause. Based on interviews conducted and records reviewed, the licensee did not comply with the above regulation due to the facility issuing a same-day eviction notice without prior written approval from the licensing agency.the state’s words, verbatim · CDSS document, Oct 15, 2024

Plan of correction: Adminsitrator stated they will conduct an in-service training with all staff regarding eviction procedures. AD stated they will document the topics covered, staff in attendance and date/time of the training. AD stated they will email LPA documentation related to training by the POC due date.

Type of visit: Case Management - Other

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit for the purpose of conducting a case management inspection. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrator Evan Tran was notified and interviewed via telephone. On September 20, 2024, resident R1 was stated to have undergone a medical and behavioral episode which saw R1's blood pressure climb to 180 over 113 as well as hitting staff member S1. R1's blood pressure was reduced and 911 was called. After the 911 call, R1 hit staff member S2. R1's condition is stated to have improved while at the hospital however administrator declined to readmit the resident due to safety concerns for staff members and the four other residents. R1 was stated to reside at the facility with spouse R2. R1 was discharged to a new facility and R2 moved out earlier on the day of the present visit. Facility administrator was unable to provide information on the new facility where both were R1's assessment did not evidence any aggressive behavior upon admission. A copy of R1's resident records, medication administration records and staff notes for the months of August and September 2024 were obtained during the visit. An exit interview was conducted via telephone and a copy of this report was provided to facility administrator.the state’s words, verbatim · CDSS document, Sep 23, 2024

Type of visit: Prelicensing

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made a scheduled visit to the facility for the purpose of conducting a pre-licensing inspection. LPA was greeted and granted entry by Evan Tran, administrator. An initial application for a license to operate as a Residential Care Facility for the Elderly was received by the Department on December 18, 2023 for a capacity of six non-ambulatory residents. This is a change of ownership with six residents already in care. None of the currently admitted individuals are receiving hospice care. The applicant has requested a hospice waiver for six residents. LPA accompanied by administrator toured the physical plant. The facility is a one-level home with a frontyard, backyard and attached garage. There are two shared bedrooms and two private bedrooms with one shared bathroom, one en-suite bathroom accessible from the shared master bedroom and a powder room next to the common living area. Each of the bedrooms include all necessary components of furnishing including a light, chair, storage space for personal items and a full-size bed as well as a supply of linen and bedsheets. Water temperature was measured at 110F, which is within the required range. Common living spaces are present and an internet connection is present for the use of the residents in care. Facility is clean, sanitary and free of odors in all areas inspected. Required posted documents are observed to be present. Kitchen equipment is present and operating as required. Sharp items and cleaning supplies are confirmed to be secured. A sufficient supply of perishable and non-perishable food is present as required by Title 22 Regulations. The centrally stored medication storage is located in a secure cabinet with a key lock. LPA provided applicant with a consultation on pre-pouring of medication. The garage is used for additional storage of food along with emergency and back-up supplies along with a laundry area. The entrance to the garage is also secured with a digital lock. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 Staff and six client records were reviewed and confirmed to include all necessary components. The fire clearance has been obtained and provided to the Department prior to the pre-licensing visit. Combined smoke and carbon monoxide detectors are observed throughout the facility and confirmed to be functional. Fire extinguishers present on the premises are observed to be charged with current maintenance tags. First aid kit verified to be complete. LPA and licensee toured the outside of the facility and observed it to be free of obstructions. One shaded area is present in the backyard and is equipped with outdoor furniture for the enjoyment of residents and visitors. The perimeter gates present on one side of the premises is self-latching and can easily be opened in an evacuation. There are no bodies of water on the premises. Component III was waived as the prospective licensee has already been acting as the current facility administrator and operates other licensed locations as well. This report was reviewed with facility representative and a copy of this report was emailed to the prospective licensee before the conclusion of the visit.the state’s words, verbatim · CDSS document, Aug 9, 2024

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 6 Method: Telephone call with CAB COMP II Participants: Evan Tran, Administrator/Owner; Shannon Betker, analyst. Applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. 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. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jul 11, 2024