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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850356
Report Date: 09/20/2024
Date Signed: 09/20/2024 01:03:20 PM


Document Has Been Signed on 09/20/2024 01:03 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:
09/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Knarik DavtyanTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 11:55 AM. LPA met with facility administrator Knarik Davtyan. The facility administrator advised LPA that the facility does not currently have residents.

Beginning at 11:56 AM, the LPA along with the facility administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

Fire extinguisher was fully charged and was serviced on 09/01/2023. Combination smoke and carbon monoxide detectors were tested at 12:11 PM and all were functional at the time of the visit. No fire clearance concerns were observed.

KITCHEN: The kitchen was observed to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured cabinet to contain knives, lighters, and other sharp objects. LPA observed a secured cabinet designated to store resident medications and 1st aid supplies.

COMMON AREAS: This includes the living room and entry area. LPA observed the living room to be clean and properly furnished. Auditory alarms on the exit door to the backyard were functioning at the time of the visit. The living room was observed to contain activities for resident use. The entryway was observed to be clean and contained all requires postings. The entryway contains a fireplace and adequate seating. LPA observed the facility hallway to contain a pantry that contained adequate emergency food supplies. The LPA observed two hallway closets to contain extra linens and space for resident storage.

Continued on 809C.

SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Trevor ByrneTELEPHONE: 747-444-6104
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4


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: PARADISE SENIOR HOME
FACILITY NUMBER: 195850356
VISIT DATE: 09/20/2024
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BATHROOMS: There are two (2) bathrooms for resident use. One (1) is a shared resident bathroom and one (1) is a private resident bathroom. Restrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed in the bathrooms and all were secured at the time of the visit. The water temperature was measured in both restrooms between 111.2 and 112.6 degrees Fahrenheit which is in compliance with regulation.

GARAGE: The garage was observed to be appropriately secured. The garage contains adequate emergency water, a washer and dryer, extra care supplies, and appropriately stored cleaning supplies.

BEDROOMS: There are four (4) total bedrooms in the facility. Two (2) rooms are designated as dual occupancy rooms and two (2) are single occupancy rooms. Bedroom #1 is designated as the bedridden approved room. Resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. All resident bedrooms were equipped with emergency flashlights.



OUTDOOR SPACE: The backyard has patio furniture including shaded tables and chairs for resident use. The facility has clear passageways for emergency exit use. No bodies of water were noted at the facility. All ramps observed were secured properly and were in good repair.

Due to no residents in care no citations were issued. LPA reminded the facility administrator to notify CCL upon the acceptance of their first resident.

Exit interview conducted and report was issued.

SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Trevor ByrneTELEPHONE: 747-444-6104
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024
LIC809 (FAS) - (06/04)
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