197608745-8-4-2023-31-AS-RORN-D5STRY-20240531145819

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608745
Report Date: 08/04/2023
Date Signed: 08/04/2023 03:12:47 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/05/2023 and conducted by Evaluator Mariana Agban

COMPLAINT CONTROL NUMBER: 31-AS-20230605114154

FACILITY NAME:	PARADISE SENIOR LIVING -1		FACILITY NUMBER:	197608745
ADMINISTRATOR:	ANGELA ANGLE APOYAN		FACILITY TYPE:	740
ADDRESS:	8435 AURA AVENUE		TELEPHONE:	(818) 626-3338
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91324
CAPACITY:	6	CENSUS: 3	DATE:	08/04/2023
		UNANNOUNCED	TIME BEGAN:	10:02 AM
MET WITH:	Angela Apoyan-Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility refused to accept resident back from hospital.

INVESTIGATION FINDINGS:

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On 08/04/2023 Licensing Program Analyst (LPA) Mariana Agban conucted a subsequent complaint visit to facility to investigate the above allegation. Upon entrace LPA were greeted by Staff #1 (S1) who granted access to the facility. Adminstator arrived shortly after and LPA expained the reason for the visit.

Allegation: Facility refused to accept resident back from hospital.
It was alleged that Facility refused to accept resident back from hospital. Administrator refused to accept Resident #1 (R1) back after discharge from the hospital. According to the administrator,the reasons for the unlawful eviction is due to resident's failure to comply with general policies of the facility, facility house rules, and nonpayment of the appropriate amount after several notices of increase of montly payments. LPA was provided with copies of notices of payment incraese and correspondce messages and emails between R1's POA and administrator.
Continue on LIC9099C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana Agban	TELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

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-20230605114154

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 -1	FACILITY NUMBER: 197608745
	VISIT DATE: 08/04/2023

NARRATIVE

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LPA verified that the Administrator had provided multiple eviction notes to CCLD which were all rejected due to eviction requirements have not been met. Administrator has failed to provided efficient 60 day eviction notice to R1 which deem unlawful eviction.

Based on LPA's observations and interviews conducted, and records gathered.The allegation is SUBSTANTIATED.

The following deficiency was cited per California Code of Regulations, Title 22. Refer to 9099D.
Exit interview conducted and a copy of the report and appeal rights were provided.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana Agban	TELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20230605114154

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 -1	FACILITY NUMBER: 197608745
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/04/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/04/2023 Section Cited CCR 87224(a)	1 2 3 4 5 6 7	The licensee may evict a resident for one or more of the reasons listed in Section 87224(a). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph	1 2 3 4 5 6 7	Facility will accept R-1 back into residence as of 08/05/2023. Administrator will provide CCLD with the written documentation stating that Administrator has granted the right to R1 to move in.
	8 9 10 11 12 13 14	Based on information provided during interview by Administrator and LPA’s observations during records review. The facility failed to properly provide R-1 with legal eviction notice and/or file in superior court for an unlawful detainer.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana Agban	TELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

LIC9099 (FAS) - (06/04)

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