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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850588
Report Date: 03/20/2025
Date Signed: 03/20/2025 10:29:52 AM

Document Has Been Signed on 03/20/2025 10:29 AM - 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:
03/20/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Narek NersisyanTIME VISIT/
INSPECTION COMPLETED:
10:25 AM
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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.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2025
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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