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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608745
Report Date: 01/27/2023
Date Signed: 01/27/2023 11:57:26 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/11/2021 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20210511160041
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: 5DATE:
01/27/2023
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Angela ApoyanTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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1. Staff mismanaged resident's medication
2. Authorized representative did not receive a signed admissions agreement
3. Staff did not keep resident's personal information confidential
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted a subsequent visit and met with Administrator Angela Apoyan, who was informed the reason of the visit. LPA delivered the final findings to the allegations mentioned above.

Allegation # 1: It was alleged staff mismanaged resident's medication. On 05/20/2021, 09/16/2021, and 11/01/2022, from various times, ranging from 930am to 330pm, LPA reviewed resident records, and conducted interviews with the complainant, staff, and resident #1 (R1). Information revealed that resident # 1 (R1’s) medication is prepared, distributed and provided to the facility by R1’s pharmacy. Interviews also reported, that R1’s power of attorney (POA) has arranged medication to be handled by the pharmacy and not the facility. LPA observed R1’s insulin schedule, and R1 reported to LPA that there have been no issues by staff in conjunction to R1’s insulin. LPA also reviewed R1's medication supply and locked cabinet, and it was observed to be in compliance, and records demonstrated that medication is being distributed according to doctor's orders. Therefore, based on interviews and documentation, LPA could not prove the allegation,
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023
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 5
Control Number 31-AS-20210511160041
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 -1
FACILITY NUMBER: 197608745
VISIT DATE: 01/27/2023
NARRATIVE
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which will be UNSUBSTANTIATED at this time.

Allegation # 2: Authorized representative did not receive a signed admissions agreement. On 05/20/2021, 09/16/2021, and 11/01/2022, from various times, ranging from 930am to 330pm, LPA reviewed resident records, and conducted interviews with the complainant, staff, and resident #1 (R1). Concerns were expressed after R1 was admitted to the facility, the POA (Power of Attorney) did not receive the admission agreement in a timely manner. Information revealed to LPA, and documentation received, it was reported to LPA by the Administrator, that due to the POA residing in another country, there was minimal contact and all facility documents had to be completed and signed via email. LPA received those documents and based on review, it was observed that the Administrator submitted the admission agreement with her initials, and were eventually signed by the POA and submitted to Administrator. Therefore, based on record review and interviews, LPA does not have sufficient evidence to prove the allegation, and it is UNSUBSTANTIATED at this time.

Allegation # 3: Staff did not keep resident's personal information confidential. On 05/20/2021, 09/16/2021, and 11/01/2022, from various times, ranging from 930am to 330pm, LPA reviewed resident records, and conducted interviews with the complainant, staff, and resident #1 (R1). There were concerns resident's personal and confidential information is being disclosed in front of other residents. LPA conducted interviews, including R1, and it was reported to LPA they have not observed any such conduct from staff or others. Conversations are disclosed privately amongst staff and residents in a safe environment. Therefore, based on interviews, LPA determined there is insufficient evidence to prove the allegation, and it is UNSUBSTANTIATED at this time.

Exit interview and copy of report provided.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/11/2021 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20210511160041

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: 5DATE:
01/27/2023
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Angela ApoyanTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Resident was not provided a rent increase letter
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted a subsequent visit and met with Administrator Angela Apoyan, who was informed the reason of the visit. LPA delivered the final findings to the allegations mentioned above.

Allegation # 1: Resident was not provided a rent increase letter. On 05/20/2021, 09/16/2021, and 11/01/2022, from various times, ranging from 930am to 330pm, LPA reviewed resident records, and conducted interviews with the complainant, staff, and resident #1 (R1). Concerns were expressed that R1’s POA (Power of Attorney) was not properly notified of a rent increase. LPA interviewed the Administrator and requested a copy of the rental increase letter. It was determined that the Administrator texted the rental increase to the POA; which was an improper and non-compliant Licensing format for rental increase. Therefore, LPA determined that the rental increase was invalid, and the allegation is SUBSTANTIATED at this time. LPA will note that Administrator has submitted several eviction notices pertaining to R1, and have been reviewed by current LPA Joscelyn Martinez, which at this time, the Administrator is still working with LPA to resolve the issue.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 31-AS-20210511160041
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 -1
FACILITY NUMBER: 197608745
VISIT DATE: 01/27/2023
NARRATIVE
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Therefore, the citation and POC will be cleared during today’s visit.

Exit interview and copy of report provided, including appeals document.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20210511160041
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 -1
FACILITY NUMBER: 197608745
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/03/2023
Section Cited
CCR
87507(4)(B)
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Admission Agreement: Modification conditions, including the requirement for the provision of at least 60 days prior written notice to the resident of any rate or rate structure change...This requirement was not met evidenced by:
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POC cleared, Administrator has submitted several notices, that are currently be reviewed by current LPA. At this time, the Administrator will continue to submit until valid.
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Administrator did not submit a proper or valid rental increase letter to the POA. This is a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5