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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850356
Report Date: 09/13/2023
Date Signed: 09/13/2023 08:55:18 PM


Document Has Been Signed on 09/13/2023 08:55 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:PARADISE SENIOR HOMEFACILITY NUMBER:
195850356
ADMINISTRATOR:DAVTYAN, KNARIKFACILITY TYPE:
740
ADDRESS:7639 ALCOVE AVETELEPHONE:
(818) 601-0013
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY:6CENSUS: 0DATE:
09/13/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Knarik DavtyanTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA), Sandra Urena, conducted a subsequent pre-licensing visit. The LPA met with the applicant Knarik Davtyan and conducted a tour of the facility to ensure all corrections were done.

On 09/06/2023, a pre-licensing visit was conducted by Licensing Program Analyst (LPA), Sandra Urena. The LPA arrived at the facility at 10:30 a.m., and met with applicant Knarik Davtyan. This is a new facility application for five non-ambulatory residents, and one bedridden resident.

The following deficiencies were corrected:
1. Bedroom #1 needs one (1) bed, and linens: Corrected
2. Bedroom #2 needs two (2) beds, and linens, and one chest drawers: Corrected
3. Bedroom # 3 needs one (1) bed, and both beds need linens, and one chest drawers.:Corrected
4. Bedroom # 4 needs linens on the bed: Corrected
5. Carbon Monoxide alarm needs to be purchased and placed on the wall: Corrected
6. Sliding doors in bedroom #1 and dining room leading to the backyard require an adaptor to make the floor level and to make passage from bedroom and dining room area to outdoors at the level where wheelchairs and walkers may enter and exit the facility safely: Corrected
7. Outdoor ramp from dining room needs to be reposition to make it flushed to the sliding door: Corrected
8. Water temperatures for the kitchen and bathrooms #1 and #2 need to between 105 to 120 degrees Fahrenheit: Corrected

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 applicant Knarik Davtyan . A copy of the report was provided.

SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2023
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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