342701560-7-28-2025-27-AS-CTAO-DJZQ5W-20250728115238

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342701560
Report Date: 07/28/2025
Date Signed: 07/28/2025 11:52:47 AM

Document Has Been Signed on 07/28/2025 11:52 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
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: 2	DATE:	07/28/2025
TYPE OF VISIT:	Post Licensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:39 AM
MET WITH:	Sherry Ahuja		TIME VISIT/ INSPECTION COMPLETED:	12:16 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 7/28/2025 at 8:39 AM, Licensing Program Analyst (LPA) Cynthia Tamayo arrived at the facility for an announced to conduct a Post-licensing inspection. LPA was greeted by staff member, Sudien Crooks and explained the purpose of the visit. Facility Designated Administrator (FDA), was contacted by staff and arrived at approximately 9:15 AM. Sherry Ahuja to inform them that CCL was present at this time. LPA Cynthia Tamayo met with applicant Sherry Ahuja and explained the purpose of the visit. Sherry holds an active administrator certificate # 6062188740 and is valid until 01/30/2026. Current census was 2. This facility is licensed to serve six(6) non-ambulatory residents of which, one(1) may be bedridden in room #5. Waiver/granted for hospice care for (6). There is one staff bedroom and one staff office that are inaccessible to residents. There are currently no residents on hospice at this time. LPA reviewed 2 out of 2 resident files and 2 staff files. Resident and staff files were complete. Hot water temperatures were taken to ensure it was in the regulation of 105-120 degrees and it measured at 105.4 * F. Carbon monoxide and smoke alarms were present and were in working condition. A menu was observed in the kitchen area. Common areas for resident use were toured. Furniture and furnishings were observed to be present and in compliance. 76 degrees Fahrenheit which is within the required range of 68-85 Fahrenheit. Grab bars and non-skid mats were present and functional. Resident bedrooms were toured. Furniture and furnishing were observed to be present and in good condition. 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: 07/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2025

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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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: 07/28/2025

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A linen closet was located in the hallway and had sufficient number of linens at this time.

The kitchen area was toured. Facility freezer and refrigerator showed to be functional. LPA Tamayo observed that there were not 7 days of nonperishable food in the pantry. LPA Tamayo observed the centrally stored medications area to be locked and inaccessible to residents. The fire extinguisher(s) and first aid kits were up to date. fire extinguisher will need a re-service/replacement 12/23/2025. Smoke and carbon monoxide detector(s) were in good repair. An activity Calendar was observed in the common areas.
There is no longer a Jacuzzi hot tub located in the backyard. Two self latching gate doors observed in the backyard.

As a result of this post licensing visit, the facility is in compliance with Title 22 Regulation. An exit interview was conducted with Sherry Ahuja, and a copy of these LIC 809 reports were provided to the facility.

NAME OF LICENSING PROGRAM MANAGER: Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM ANALYST: Cynthia Tamayo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2025

LIC809 (FAS) - (06/04)

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