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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197604446
Report Date: 12/20/2021
Date Signed: 12/20/2021 01:43:50 PM

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:
197604446
ADMINISTRATOR:GAMBURD, RAISSAFACILITY TYPE:
740
ADDRESS:825 LARRABEE ST.TELEPHONE:
(310) 289-8834
CITY:WEST HOLLYWOODSTATE: CAZIP CODE:
90069
CAPACITY:9CENSUS: 0DATE:
12/20/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Wilber MontoyaTIME COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) LaQueena Lacy conducted an unannounced case management visit to the facility to ensure that there are no residents in care. The Executive Director Robin Wilder informed LPA that the facility was closing. LPA met with staff Wilber Montoya. LPA discussed the purpose of the visit with Rosie Sukiasyan.

At 10:50am LPA arrived at the facility. At 11:15am a physical plant tour was conducted of the facility. LPA inspected six (06) resident bedrooms. All rooms were vacant. There were no residents in care occupying any of the bedrooms. LPA observed inside of all bedrooms and dresser drawers. LPA observed no residents’ personal items, per staff Wilber Montoya items left behind will be discard in the trash, and all furniture will be moved to other properties.

Exit interview conducted. A copy of the report was issued.









SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 586-4368
LICENSING EVALUATOR NAME: LaQueena LacyTELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021
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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