Gentle Guardian Senior Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct the required annual visit today at 09:30am. Upon arrival, the LPA was greeted by staff who then contacted the Administrator, Narek Nersisyan and informed them of the visit. The Administrator arrived at approximately 10:10am and the reason for the visit was explained. Entrance interview conducted. Beginning at 10:15am, the LPA along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and facility is in compliance with Title 22 Regulations. The following was observed: Kitchen: The LPA inspected the kitchen/food service area at approximately 10:17am. Knives and sharps were observed in a kitchen drawer locked and inaccessible at the time of the visit. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Cleaning supplies were observed under the kitchen sink inaccessible to residents at the time of the visit. At 10:19am, the hot water temperature was measured in the kitchen sink at it measured at 109.8 degrees Fahrenheit. Common Areas: This includes the living room and dining room. Furniture in the common areas was observed to be in good condition at the time of the visit. The facility maintained a comfortable temperature. Required postings were observed throughout the common space. There is a working telephone on premises. Fire extinguisher was observed to be new with a purchase date of 05/26/2026. The LPA observed an adequate amount of emergency food and water. At 10:30am, the smoke detector and carbon monoxide detector were tested and functional at the time of the visit. Report Continued on LIC 809C... Report Continued from LIC 809... Garage: The garage does not have direct access from the house and is currently being used as storage. Laundry: Washer and dryer were observed in the backyard. Detergents and toxins were observed locked at the time of the visit. Restrooms: There are three (3) restrooms for residents use. Bathroom were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. Starting at 10:23am, the hot water temperature was measured in all three (3) bathrooms, and they all measured within the required range of 105 – 120 degrees Fahrenheit at the time of the visit. Bedrooms: There are four (4) bedrooms for residents use. Two (2) bedrooms are designated as private / single occupancy, and two (2) bedrooms are designated as shared / double occupancy. Bedrooms were observed to be furnished appropriately with appropriate furnishings, and sufficient lighting. Additional clean linens and towels were observed in a closet in the hallway. Outdoors: The front yard has a covered patio area with patio furniture for residents’ use. There is one (1) side gate for emergency purposes. All passageways were observed to be clear of any obstructions. No bodies of water noted at the time of the visit. Records: Record review began at approximately 10:35am Six (6) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, preplacement appraisal, consent for treatment form, and updated/current appraisal & needs and services plan. All files were in order. Three (3) personnel files including the current Administrator’s file were reviewed for, but not limited to: personnel records, health assessments with negative TB test results, criminal record clearances, first aid/CPR training, and the appropriate yearly training. All personnel files were complete. The Administrator’s Certificate is valid until January 2027. Report Continued on LIC 809C... Report Continued from LIC 809C... Emergency Disaster Planning: The LPA reviewed the facility's infection control plan and emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. The LPA observed the emergency disaster plan to be complete. Emergency disaster drills conducted quarterly as per regulation. Medications: Medications review began at approximately 12:15pm. Medications are centrally stored and kept in a locked cabinet by the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Per records review, 1 out of 6 residents records did not have updated start dates on centrally stored records. The Administrator stated all medication records will be reviewed and updated. The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Exit interview conducted. A copy of report and appeal rights were provided.the state’s words, verbatim · CDSS document, May 26, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Sandra Urena conducted a follow up Pre-licensing visit and met with the applicant Narek Nersisyan. This is a new facility application for a Residential Facility for the Elderly (RCFE) for six (6) non-ambulatory residents; one (1) of which may be a bedridden resident(s). Waiver was granted for hospice care for six (6) residents. Fire Clearance was approved on 10/28/2024. Bedridden approved in bedroom #2. Pre-Licensing is complete, and deficiencies were resolved. · Applicant will add a small threshold ramp so that the wheelchair/walkers may and exit room #2 safely. · Applicant will add floor sketches with emergency evacuation plan to each bedroom and to common area. · Applicant will check and verify that the Carbon Monoxide alarm is operational. · Applicant will work on contacting the CAB analyst about getting the ADU tenants Background cleared and associated to the facility. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview was conducted and reviewed with the applicant. A copy of the report was issued.the state’s words, verbatim · CDSS document, Mar 20, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Sandra Urena conducted a Pre-licensing visit and met with the applicant Narek Nersisyan. This is a new facility application for a Residential Facility for the Elderly (RCFE) for six (6) non-ambulatory residents; one (1) of which may be a bedridden resident(s). Waiver was granted for hospice care for six (6) residents. Fire Clearance was approved on 10/28/2024. Bedridden approved in bedroom #2. ADU unit NOT INCLUDED in fire clearance. At 10:05 a.m., the LPA, and the applicant toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility will be following Title 22 Regulations. COMMON AREAS: The living room area is equipped with a television, and table games. There is a dedicated area for the posting of required documents at the entrance of the facility. Smoke alarm were tested and functional at the time of the visit. The residents’ and staff files will be stored and locked in a file cabinet located in the corner of the common area. KITCHEN: Kitchen knives are stored locked and inaccessible in a locked kitchen drawer. A seven-day supply of non-perishable food was available. The supply of dishes is adequate. Appliances in the kitchen were clean and all appeared functional. Kitchen cleaning supplies will be stored and locked under the kitchen sink. Hot water temperature was recorded at 113.5 degrees Fahrenheit. Trash cans have a tight-fitting lid. There were no pesticides or toxins stored near food, or preparation area. Medications will be stored in a top locked cabinet in the kitchen area. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. A fire extinguisher is located near the backdoor exit, which was purchased on 08/14/2024. LAUNDRY: The washer and dryer are located outside in the backyard area. Detergents and cleaning supplies will be stored in a locked cabinet under the kitchen sink. BEDROOMS: There are four (4) bedrooms for residents in care. Rooms # 1 and 2 will be used as private rooms. Room #2 is approved for one (1) bedridden resident. Rooms # 3 and 4 will be shared rooms; all bedrooms are cleared for non-ambulatory. All bedrooms were supplied with all required bedding and linens. There is sufficient lighting as well as closet and drawer space available. Linen closet is located outside bedroom #4, and has a sufficient supply of linens. Continues on LIC 809C... BATHROOMS: There are three (3) full bathrooms, with showers. Bathrooms are equipped with toilets and shower grab bars, and non-skid mats. There are sufficient supplies of towels, paper goods and personal hygiene supplies. Hot water delivered at 113.5 degrees Fahrenheit. Applicant will add hand washing signs to all bathrooms. SURROUNDING GROUNDS/OUTDOOR AREA: The exterior passageways were clean. The patio is furnished with outdoor chairs for residents’ use, and shade is available. The building has a central entrance for residents and visitors. At the time of the visit the LPA observed one (1) ADU unit behind the facility. The unit is identified by the address as # 15554 and is located behind the facility. The ADU unit is not separated from the main address by a fence and is accessible to residents in care. Applicant will work on contacting the CAB analyst about getting the ADU tenants Background cleared and associated to the facility. Pre-Licensing is incomplete with deficiencies to be resolved by 03/06/2025. Follow up Pre-licensure LIC809 will be generated upon resolution. Applicant will add a small threshold ramp so that the wheelchair/walkers may and exit room #2 safely. Applicant will add floor sketches with emergency evacuation plan to each bedroom and to common area. Applicant will check and verify that the Carbon Monoxide alarm is operational. Applicant will work on contacting the CAB analyst about getting the ADU tenants Background cleared and associated to the facility. The applicant completed Component III Orientation. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview was conducted and reviewed with the applicant. A copy of the report was issued via email.the state’s words, verbatim · CDSS document, Feb 20, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Method: Telephone call with CAB COMP II Participants: Nersisyan, Narek On 1/27/25, the 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, Jan 27, 2025