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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197604445
Report Date: 06/04/2021
Date Signed: 06/04/2021 10:07:09 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:RAYA'S PARADISE, INC.FACILITY NUMBER:
197604445
ADMINISTRATOR:MOTI GAMBURDFACILITY TYPE:
740
ADDRESS:1156 N. GARDNER ST.TELEPHONE:
(323) 851-2517
CITY:WEST HOLLYWOODSTATE: CAZIP CODE:
90046
CAPACITY:11CENSUS: 7DATE:
06/04/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ruby Cruz/ Executive DirectorTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility and was greeted by the Executive Director, Ruby Cruz.

LPA was able to tour the facility inside and out. Temperature checks are conducted on all visitors as they enter and are taken to a hand washing station before being allowed entry. All staff were observed to be wearing masks.

Signs were observed throughout the facility and bathrooms, reminding residents and staff to wash their hands and to wear masks. Facility is following all of their mitigation protocols.

No health and safety concerns were observed during todays visit. Exit interview conducted and report issued.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick ShanahanTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2021
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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