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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850588
Report Date: 02/20/2025
Date Signed: 02/20/2025 03:13:10 PM

Document Has Been Signed on 02/20/2025 03:13 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:GENTLE GUARDIAN SENIOR CAREFACILITY NUMBER:
195850588
ADMINISTRATOR/
DIRECTOR:		NERSISYAN, NAREKFACILITY TYPE:
740
ADDRESS:15556 SATICOY STREETTELEPHONE:
(818) 450-7206
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 6CENSUS: 0DATE:
02/20/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Narek NersisyanTIME VISIT/
INSPECTION COMPLETED:
01:50 PM
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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...
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: GENTLE GUARDIAN SENIOR CARE
FACILITY NUMBER: 195850588
VISIT DATE: 02/20/2025
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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.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC809 (FAS) - (06/04)
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