197609312-12-19-2023-31-AS-TAGD-CZMTQD-20240119135546

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609312
Report Date: 12/19/2023
Date Signed: 12/19/2023 02:16:46 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
12/14/2023 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20231214143834

FACILITY NAME:	A PARADISE IN THE VALLEY		FACILITY NUMBER:	197609312
ADMINISTRATOR:	DER-APRAHAMIAN, ARSEN		FACILITY TYPE:	740
ADDRESS:	7754 TEXHOMA AVE		TELEPHONE:	(323) 821-1419
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	6	CENSUS: 3	DATE:	12/19/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Arsen Der-Aprahamian		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff do not accord reasonable level of privacy to residents in care

INVESTIGATION FINDINGS:

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On 12/19/23, at 09:30am, Licensing Program Analyst (LPA) Gina Saucedo and Tihesha Smith arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by a staff. Administrator, Arsen Der-Aprahamian arrived later. LPA’s requested the census, staff, and resident files.

Regarding the allegation: Staff do not accord reasonable level of privacy to residents in care. It is alleged that there is a camera in the room on top of the table or sometimes on top of the dresser. At 10:05 am, LPA's conducted the physical tour and observed a camera to be in Resident #1 (R1) and Resident #2 (R2)'s room on top of the dresser. Therefore, based on LPA's observations there is a preponderance of evidence to substantiate the above allegation(s). Per the California Code of Regulations, Title 22, deficiency is cited on the attached LIC-9099D.

An exit interview was conducted, citation given, appeal rights, and a copy of this report was given to the administrator.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

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-20231214143834

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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: 12/19/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/19/2023 Section Cited CCR 87468.2(a)(1)	1 2 3 4 5 6 7	87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The licensee/administrator immediately removed the camera from the top of the dresser. POC 12/20/23
	8 9 10 11 12 13 14	Based on the observation and interviews the licensee/administrator did not ensure two out of three residents at the facility to have privacy thus violating their personal rights which poses immediate Health, Safety or Personal Rights risks to person in care.	8 9 10 11 12 13 14	Defiency cleared at time of visit.
	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: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

LIC9099 (FAS) - (06/04)

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