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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608745
Report Date: 01/08/2024
Date Signed: 01/09/2024 10:21:43 AM


Document Has Been Signed on 01/09/2024 10:21 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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: 4DATE:
01/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:57 AM
MET WITH:Helen Ichmelyan - CaregiverTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with staff, Helen Ichmelyan and explained the reason for the visit. At approximately 11:15 am, with the assistance of staff, LPA took a tour of the physical plant to ensure the health and safety of the residents are protected and that the physical plant complies with Title 22 Regulations. Required postings were observed in the entry area. The facility is a two-story building. The facility sketch that was submitted to CCL was just for the first floor. From the first floor, there is a stairwell that leads to the 2nd floor. The stairwell has a door that is being kept locked. On the 2nd floor, there are two bedrooms each has a bathroom and two balconies. The 2nd floor is furnished. Staff stated that the 2nd floor is being used by the landlord. The landlord lives out of the country and once or twice a year comes back to the country. The 2nd floor is being used as storage for the Landlord's belongings. Staff mentioned that they currently live in one of the rooms on the 2nd floor. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the kitchen cabinets. The fire extinguisher is located in the kitchen with a purchase date of July 11, 2023. Bedrooms: There were four (4) bedrooms designated for residents' use. Three (3) bedrooms are designated for private use, and one (1) room is shared. All four bedrooms, in use by residents, were properly furnished with appropriate bedding and linens with sufficient lighting. Bathrooms: There are two (2) bathrooms designated for residents' use. Both bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured from the bathroom sink at 105.7 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. Laundry Area: The laundry area is located in the garage which is inaccessible to residents. Resident Files: LPA conducted a file review of resident records to ensure compliance of licensing forms. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and in compliance with licensing forms.
Medications: Medication and Medication Records were reviewed for proper documentation.
Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana AgbanTELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:
DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2024
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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