<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608745
Report Date: 11/23/2021
Date Signed: 12/27/2021 11:04:56 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:PARADISE SENIOR LIVING -1FACILITY NUMBER:
197608745
ADMINISTRATOR:ANGELA ANGLE APOYANFACILITY TYPE:
740
ADDRESS:8435 AURA AVENUETELEPHONE:
(818) 626-3338
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY:6CENSUS: 6DATE:
11/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Helen Ichmelyan TIME COMPLETED:
11:40 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Angelica Arambulo conducted an unannounced required annual visit. Upon entry LPA was greeted staff Helen Ichmelyan. The staff screened LPA temperature and no questionnaire was used to aske LPA questions, The administrator Angela Aposyan was contacted by phone and informed about the reason for the visit. She was too far away and could not come to the facility. LPA asked for permission to have staff do the visit and sign the report. Angela agreed. The administrator Angela was asked about the Mitigation plan. She said she did not have a copy at the facility. LPA informed her to make sure she prints it and keeps a copy at the facility as required.

There are currently 6 residents in the home and one staff person. LPA observed that the postes for covid awareness is up on the entry wall. Visitors and special visitors signs are also posted along with the Long term care ombudsman and Let us no signage. Each room of residents was observed and each resident has hand sanitizer and tissue paper. All bathrooms have the hand washing signage up.

LPA tried to complete the tool but due to technical difficulties the system was not operating correctly. The report shall be sent by email to administrator for signature.

SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Angelica ArambuloTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:

DATE: 11/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1