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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608609
Report Date: 10/16/2023
Date Signed: 10/16/2023 01:55:30 PM

Document Has Been Signed on 10/16/2023 01:55 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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:PARADISE HOMEFACILITY NUMBER:
197608609
ADMINISTRATOR:MUSTAPHA ALABIFACILITY TYPE:
735
ADDRESS:20319 CEDARCREEK STREETTELEPHONE:
(661) 367-6524
CITY:CANYON COUNTRYSTATE: CAZIP CODE:
91351
CAPACITY: 4CENSUS: 4DATE:
10/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Mustapha AlabiTIME COMPLETED:
02:15 PM
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Licensing Program Analysts (LPA's) Gina Saucedo and Tuesday Cabiness arrived at the facility at 11:08 am to conduct an annual inspection. LPA's were greeted by the caregiver Ricky Coleman, who allowed LPA's to enter. Administrator Nannette Mustapha arrived at 11:20 am, and everyone was informed the reason of the visit. A complete inspection/tour of the facility was conducted from the inside and outside. The following was observed during the inspection:

Entrance Area: LPA's observed the following documents as we walked around the facility-Licensee certificate on the wall along with the Rights of Individual with Developmental Disabilities. In addition, a sign in sheet for visitor and clients in and out of the facility. There is a pantry area locked with proper food storage. Next to the pantry area is another door which is locked with chemicals stored in it. The living room area had the daily food menu, house rules, activity schedule, emergency evacuation, emergency contact, complaint poster, grievance procedure, staff schedule, covid signs and emergency and disaster plan paperwork against the wall on top of the fireplace. This area also contained the locked medication for clients and the First Aid/CPR manual stored. The fireplace has a secure area. Dining: All indoor passageways were free from obstruction; inside temperature was comfortable, with adequate lighting, and all areas were clean and appropriately furnished for client’s comfort. The kitchen area has enough food for a requirement of (4) four clients. There is nonperishable and perishable, with extra refrigerator for staff in the staff office and a deep freezer stocked with food in the garage. Food was properly wrapped, and appliances were functional, clean, and in good repair. More chemicals, household supplies, and knives are stored in the kitchen locked under the sink area and the garage area were also locked and secured.

809 (c) continued

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: PARADISE HOME
FACILITY NUMBER: 197608609
VISIT DATE: 10/16/2023
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Surrounding Grounds: There were no visible hazards; passageways were free from obstruction and gates were easily accessible to open and close during the tour. The facility has outdoor furniture, with a covered shaded area for clients and visitors. The facility has a swimming pool/body of water that is fence and lock with a padlock. Laundry detergents, cleaning agents and other toxins are stored in a locked cabinet in the garage along with a washer and dryer. The fire extinguisher was fully charged located next to the kitchen area. In addition, the carbon monoxide and smoke alarm was tested. Bedrooms: The facility has four (4) bedrooms for clients. All bedrooms were properly furnished and supplied with appropriate bedding and linens. One bedroom has a full, equipped bathroom but the hot water was measured at 131.7 degrees Fahrenheit. A Technical Assistance was given due to hot water exceeding the temperature. Another bathroom fully equipped was located down the hallway.

Record review: A complete record review of staff and clients were conducted, all required documents were in file except for incident reports may not have been faxed to correct number. The administrator reported some of the clients had behavior issues but no SIR's have been received by the licensee. Medication review: no errors.

Exit interview and copy of report provided, and technical assistance issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2023
LIC809 (FAS) - (06/04)
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