342701560-3-6-2026-27-AS-CTAO-DRWVGH-20260306152534

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342701560
Report Date: 03/06/2026
Date Signed: 03/06/2026 03:25:53 PM

Document Has Been Signed on 03/06/2026 03:25 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	GIAN SENIOR LIVING		FACILITY NUMBER:	342701560
ADMINISTRATOR/ DIRECTOR:	AHUJA, SHERRY V.		FACILITY TYPE:	740
ADDRESS:	10143 OMEARA DR		TELEPHONE:	(916) 306-4784
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95829
CAPACITY: 6		CENSUS: 6	DATE:	03/06/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:45 AM
MET WITH:	Sherry Ahujua		TIME VISIT/ INSPECTION COMPLETED:	03:33 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 3/6/26 at 1:45PM Licensing Program Analyst (LPA) Cynthia Tamayo arrived at GIan Senior Living r the purpose of conducting a required 1 year annual inspection. LPA met with Administrator, Sherry Ahujua (S1), and together conducted a tour of the home. An entrance interview was conducted. Gian Senior Living is a Residential Care Elderly licensed to serve six adults age range 60 and over. Approved fire clearance for six(6) non-ambulatory of which, one(1) may be bedridden in room #5. Waiver/granted for hospice care for (6). LPA and Administrator evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor. LPA observed that all rooms are equipped with the required furniture throughout the facility. LPA observed R1 and R2 to have full bed rails in their beds during this visit. Record review shows R1 has a physician order for full bed rails. Record review shows R2 does not have physicians order for full bed rail, bottom rail was removed during this visit. R2 is listed as Non ambulatory on their current LIC 602 (dated 8/2025), S1 stated reassessment is needed for ambulatory status assessment for R2. LPA provided guidance regarding ambulatory status, full bed rails, restraints, and personal rights. LPA observed a posted menu. S1 stated special diets are followed as one have diabetes and one is on a cardiac diet reviewed records for 3 staff and 6 residents. Administrator certificate for S1 is 7027497740 and expires 1/30/2028. CONTINUED ON 809-C

NAME OF LICENSING PROGRAM MANAGER: Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM ANALYST: Cynthia Tamayo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/06/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GIAN SENIOR LIVING	FACILITY NUMBER: 342701560
	VISIT DATE: 03/06/2026

NARRATIVE

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LPA measured the water temperature, temperature measured at 106.7 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications secure from residents. The Medication Administration Record (MAR) was not complete from 3/4/26-3-6/26 regarding accurate record keeping. LPA provided guidance to S1. S1 stated all resident have received their medications from 3/4-6 and ensured the MAR was completed by the designated staff during this visit.

LPA Requested the following documents for facility file: LIC 308 Designation of Facility Responsibility, LIC 500 personnel report, LIC 999 Facility Sketch, LIC 9020 client roster and current administrator certificate.

Per California Code of Regulations, Title 22 there were deficiencies cited during today's inspection, see 809-D. Appeal Rights provided. An exit interview was conducted, and a copy of this report was left at the facility with licensee

NAME OF LICENSING PROGRAM MANAGER: Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM ANALYST: Cynthia Tamayo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/06/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/06/2026 03:25 PM - It Cannot Be Edited

Created By: Cynthia Tamayo On 03/06/2026 at 03:12 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GIAN SENIOR LIVING	FACILITY NUMBER: 342701560
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/06/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87608(a)(5)(B)

Postural Supports

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in [1] out of [1] resident whom had a full bed rail set up during this visit, in which there is no physicians order for full bed rail. This poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/07/2026
	Plan of Correction
1 2 3 4	During this visit LPA observed the bottom rail was removed during this visit by care staff. Licensee stated they will complete training on personal rights and postural supports for all care staff by 3/7/26.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM MANAGER:

	Cynthia Tamayo
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/06/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2026

LIC809 (FAS) - (06/04)

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