197604445-9-10-2024-31-AS-NGID-D9NNZV-20241002105456

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197604445
Report Date: 09/10/2024
Date Signed: 09/10/2024 02:47:04 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/05/2023 and conducted by Evaluator Huma Rahimi

COMPLAINT CONTROL NUMBER: 31-AS-20230705081809

FACILITY NAME:	RAYA'S PARADISE, INC.		FACILITY NUMBER:	197604445
ADMINISTRATOR:	MOTI GAMBURD		FACILITY TYPE:	740
ADDRESS:	1156 N. GARDNER ST.		TELEPHONE:	(323) 815-8858
CITY:	WEST HOLLYWOOD	STATE: CA	ZIP CODE:	90046
CAPACITY:	11	CENSUS: 7	DATE:	09/10/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Brian Rosales, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility does not have adequate staffing to meet resident's needs.
Staff does not follow up on resident's doctor's appointments.
Staff is mismanaging resident's medications.
Facility handrail is in disrepair.

INVESTIGATION FINDINGS:

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At 10:30 AM, Licensing Program Analysts (LPAs) Huma Rahimi and Raymond Comer, conducted a subsequent complaint visit in response to the above-mentioned allegations. LPAs met with the Administrator, Brian Rosales, and explained the reason for the visit.

An initial visit was conducted on 07/10/2023 by LPA LaQueena Lacy. During today's visit, at 10:45 AM, LPAs conducted physical plant tour. At 11:00 AM, LPAs requested resident and staff roster. At 11:15 AM, LPAs requested copies of pertinent information, which includes, but is not limited, to Maintanance Repair Log, Medication Log, Transportation Log, etc., relevant to the investigation. Between 11:30 AM – 12:45 PM, the team conducted an interview with the Administrator, two (2) Staff, a Licensed Vocational Nurse, one (1) out of seven (7) residents who were able to communicate, and two (2) out of six (6) family members.

Continue on LIC 9099

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Huma Rahimi	TELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 31-AS-20230705081809

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: RAYA'S PARADISE, INC.	FACILITY NUMBER: 197604445
	VISIT DATE: 09/10/2024

NARRATIVE

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Facility does not have adequate staffing to meet resident's needs:
It was alleged that the facility is chronically understaffed. To investigate the above allegation, LPAs conducted records review and inspected the facility’s staff schedule. The schedule indicates that there are three shifts. During the day shift there are two (2) staff scheduled. During the night shift, there is only one staff available. Additionally, interviews with the Administrator and two staff revealed that they always have MedTech as a backup staff to cover for any shift, or during an emergency. Interview with a resident and two (2) out of six (6) family members did not express any concerns with the facility being understaffed. Furthermore, during today’s visit LPAs observed enough staff available to provide care and supervision to residents in care. Based on the record review, interviews and LPAs observation, this allegation is deemed Unsubstantiated at this time.

Staff does not follow up on resident's doctor's appointments:

Regarding the allegation that Staff do not follow up on resident's doctor's appointments, it was alleged that Staff do not consistently follow up on after care, nor medications directives from doctor/hospital visits. LPAs’ Huma Rahimi, and Raymond Comer, conducted a facility records review and observed that Resident#1 (R1)’s appointments were both scheduled and noted as completed with the assistance facility Staff. LPAs’ interview with the Administrator, two (2) Staff caregivers, and Staff Licensed Vocational Nurse (LVN) revealed that the staff drove residents regularly to complete resident doctor's appointments. Additionally, Staff interviews revealed that in the event of any scheduling conflicts, Staff contacted both physicians and resident’s families that appointment rescheduling was necessary. Based on LPAs’ records review, interview with staff and residents, this allegation is deemed Unsubstantiated at this time.

Staff is mismanaging resident's medications:
It was alleged that the facility has not followed on after care and/or medications for residents. To investigate the above allegation, LPAs reviewed medication log for Resident #1 (R1) and did not observe any discrepancy or missed medication. Additionally, LPAs reviewed the monthly transportation log of R1’s doctor’s appointments and did not observe any missed appointments. Furthermore, interviews with the Administrator, Licensed Vocational Nurse, and two (2) staff revealed that all scheduled doctor’s appointments are completed with the assistance of the staff or family members. LPAs were informed that the facility also provide third party transportation in case of unavailability of the facility’s transportation. Interviews with a resident and two (2) out of six (6) family members revealed that they never missed any medication or follow up doctor’s appointments. Based on the record review, interviews and LPAs observation, this allegation is deemed Unsubstantiated at this time. Continue on LIC 9099C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Huma Rahimi	TELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20230705081809

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: RAYA'S PARADISE, INC.	FACILITY NUMBER: 197604445
	VISIT DATE: 09/10/2024

NARRATIVE

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Facility handrail is in disrepair:
With regards to the allegation of facility handrails being in disrepair, it is alleged that handrails along ramp leading from kitchen to the outside courtyard area are broken and have been in disrepair for several months. LPAs’ Huma Rahimi, and Raymond Comer, conducted a physical tour of the facility and found handrails secure and in good repair. A review of the facility’s maintenance repair ticketing system shows that on July 10, 2023, a ticket was generated with high priority to repair handguard rails; documentation indicates the repair was completed the same day. Interviews conducted with residents and their conservators evidence a consensus opinion that the facility is safe, and that facility plant issues are resolved in a timely basis. Based on LPA observation, records review and interviews with residents, LPAs has determined that this allegation is deemed to be Unsubstantiated at this time.

Exit interview conducted and report issued.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Huma Rahimi	TELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

LIC9099 (FAS) - (06/04)

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