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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609312
Report Date: 09/28/2023
Date Signed: 09/28/2023 02:23:25 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/28/2023 02:23 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:A PARADISE IN THE VALLEYFACILITY NUMBER:
197609312
ADMINISTRATOR:DER-APRAHAMIAN, ARSENFACILITY TYPE:
740
ADDRESS:7754 TEXHOMA AVETELEPHONE:
(323) 821-1419
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:6CENSUS: 4DATE:
09/28/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:37 AM
MET WITH:Arsen Der-AprahamianTIME COMPLETED:
02:35 PM
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Licensing Program Analysts (LPAs), Tihesha Smith and Gina Saucedo with Licensing Program Manager (LPM) Naira Margaryan conducted an unannounced 1-year inspection continuation visit at this facility at approximately 10:35 am. Licensing staff were greeted by staff and disclosed the purpose of the visit. The administrator was contacted and arrived later.

Licensing staff conducted a tour of the physical plant at approximately 10:45 am to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

The property has an upstairs area used as staff/family live-in accommodations. The storage area where toxins are stored had bed used for family of staff sleeping area. Attached garage converted to live-in staff accommodations. There is also a sunroom added to the property.



Each bathroom has posted “wash your hands” signs and the following items available: hand soap, paper
towels, and trash cans. The hot water temperature was measured for the two (2) residents’ bathrooms to ensure it is within the required range for residents’ comfort and safety. The water temperature range was between 110.8- and -110.58-degrees Fahrenheit.

Smoke detectors/carbon monoxide detector (interconnected) were tested and operable at time of initial visit on 09/12/23.

Backyard has the following: Four Covered patio areas with four (4) tables and chairs. Patio furniture observed to be in good repair with sufficient seating for the residents.

There is an unapproved structure on property in back area consisting of a detached garage, staff live-in accommodations, laundry and storage room, and an additional bathroom.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha SmithTELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2023
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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Document Has Been Signed on 09/28/2023 02:23 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: A PARADISE IN THE VALLEY
FACILITY NUMBER: 197609312

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/29/2023
Section Cited
CCR
87608(1)

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(1) Postural supports shall be limited to appliances or devices such as braces, spring release trays, or soft ties, used to achieve proper body position and balance, to improve a resident's mobility and independent functioning, or to position rather than restrict movement including, but not limited to, preventing a resident from falling out of bed, a chair, etc. This requirement was not met as evidenced by:
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The Licensee/Administrator will contact resident physicians to obtained required medical documentation for postural supports. POC due date:09/29/2023
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Based on observation the licensee did not comply with the section cited above by using a cloth strap to restrict resident’s movement such as falling out a chair which poses an immediate health, safety or personal rights risk to persons in care.
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This citation was corrected at time of visit. Administrator received postural support precription from doctor and verifyed by LPM Margaryan.
Type A
09/29/2023
Section Cited
CCR87305(a)

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87305 (a) Prior to construction or alterations, all facilities shall obtain a building permit.
This requirement was not met as evidenced by:
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Within 24 hours the Licensee will provide a written plan of action explaining the steps they will follow to bring physical plant to compliance.
POC due date: 09/29/23.
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Based on observation and admission of Licensee/administrator he did not comply with the section cited above by making changes to facility without notifiying CCLD or obtaining required permits.
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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: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha SmithTELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/28/2023 02:23 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: A PARADISE IN THE VALLEY
FACILITY NUMBER: 197609312

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/29/2023
Section Cited
CCR
87307(a)

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87307(a) Personal Accommodations and Services. Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility.
This requirement is not met as evidenced by:
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With in 24 hours the Licensee will provide written documentation certifying that no individual will be living/sleeping in the storage room or other areas on the property that does not have approved permits from appropriate government agencies.
Poc due date:09/29/23
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Based on physical plant inspection Licensing staff observed: bed in storage room, staff accommodations in room identified as a garage, and staff room in ADU structure area which is not designated as staff rooms in the plan of operation or on facility sketch.
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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: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha SmithTELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: A PARADISE IN THE VALLEY
FACILITY NUMBER: 197609312
VISIT DATE: 09/28/2023
NARRATIVE
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(Cont from 809)

At approximately 12:50 pm, LPAs conducted record review and staff interviews. Resident files included but not limited to physicians’ assessment, admission agreements, personal rights, and centrally stored medications. Staff files reviewed for three (3) staff. Staff files had TB screenings, caregiver trainings and current First aid/AED/CPR certificates.

Citations issued, exit interview conducted, appeals and copy of report provided to Licensee.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha SmithTELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4