197608521-1-5-2024-31-AS-TAGD-DA3Q6K-20241015115334

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608521
Report Date: 01/05/2024
Date Signed: 01/05/2024 02:16:49 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.ASC, 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
01/03/2024 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20240103153651

FACILITY NAME:	EXCLUSIVE RAYA'S PARADISE, INC.		FACILITY NUMBER:	197608521
ADMINISTRATOR:	MOTI MICHAEL GAMBURD		FACILITY TYPE:	740
ADDRESS:	852 N. SIERRA BONITA AVENUE		TELEPHONE:	(323) 782-1842
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	6	CENSUS: 5	DATE:	01/05/2024
		UNANNOUNCED	TIME BEGAN:	09:36 AM
MET WITH:	Brian Rosales - Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Licensee did not provide adequate notice of fee increases to residents

Staff do not assist residents with care needs in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced complaint visit to this facility to investigate the above allegation. LPA met with administrator Brian Rosales and explained the reason for the visit.

LPA conducted physical plant tour at 9:48 AM, requested copy of facility documents relevant to the investigation at 10:29 AM and interviewed staff and residents between 11:00 AM to 1:00 PM. Regarding the allegation that the licensee did not provide adequate notice of fee increase to residents, it was alleged that a family member (FM) of Resident #1 (R1) recently received notice of an increase in costs for medical transportation services provided to residents by the facility with only a one-week notice. LPA's record review today revealed at 1:00 PM revealed that the general increase letter was issued on 12/22/23 with effective date of 03/01/24, or more than 60 days’ notice. Another letter was issued for the transportation/operations increased issued on 12/27/23 with the effective date of 02/01/24. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024

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

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20240103153651

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: EXCLUSIVE RAYA'S PARADISE, INC.	FACILITY NUMBER: 197608521
	VISIT DATE: 01/05/2024

NARRATIVE

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(continued from LIC 9099)

LPA's interview with the licensee today at 12:00 PM revealed that he made the mistake on the 2nd letter which was an amendment of the addendum of the admission agreement supposed to take effect on 03/01/24, same as the previous letter and not 02/01/24. The licensee stated that he will rescind the prior letter and re-issue the same letter with the corrected effective date or sixty (60) days after the issuance date.

Regarding the allegation that Staff do not assist residents with care needs in a timely manner, it was alleged that a caregiver refused to shower R1 because the staff came to work ill and told R1 that they were unable to help shower R1 because they were sick. LPA's interview with the staff today at around 11:22 AM revealed that there was no staff who came here to work sick. LPA's interview with the administrator confirms that all staff are not allowed to work here when they are sick and that is why they did not have any case of Covid at this facility. Further interview with staff also revealed that it was R1 who refused to get showered because R1 was coughing at that time. LPA's interview with R1 today at around 12:42 PM revealed that staff gave R1 showers regularly and no staff refused to shower R1 at any given time. LPA's interview with three (3) other aware residents also revealed that the staff provide showers regularly and no staff refused to provide showers to any of the residents interviewed.

Based on the information gathered during this visit, the allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024

LIC9099 (FAS) - (06/04)

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