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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609312
Report Date: 08/07/2024
Date Signed: 08/07/2024 01:07:10 PM


Document Has Been Signed on 08/07/2024 01:07 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
WOODLAND HILLS S.RO, 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:
08/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Arsen Der-AprahamianTIME COMPLETED:
01:15 PM
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On 08/07/24 at 8:40 AM, Licensing Program Analyst (LPA) Gina Saucedo conducted an unannounced, Annual Inspection and met with Caregiver, Julieta Avagyan. LPA asked for the census, staff and resident files. The Administrator arrived about fifteen (15) minutes later.

The physical plant was toured inside and out at 9:05 am.

Living/Dining Room Area: LPA Saucedo observed the living room furniture to be clean and in good repair. The living room has a large television. The facility maintains a comfortable temperature at 79 degrees Fahrenheit.

Bedroom: There are four (4) bedrooms for residents. One (1) of the bedrooms has a private bathroom. There is an upstairs bedroom that can be access via a door that is locked and inaccessible to the residents where the washer and dryer are located. The upstairs bedroom is for staff only. There is a private bathroom upstairs. LPA observed rooms to have bedding sheets, pillowcase, blankets, nightstands, televisions, and sufficient lighting for each of the resident’s room. In between one (1) of the rooms down the hallway is a linen pantry.

Bathrooms: There are two (2) bathrooms that are separated and were checked to make sure bathrooms were clean and in good repair that in the hallway. There is a total of four (4) bedrooms in the house. The hot water temperatures were measured within regulations of 112 degrees. The showers have non-slip bathmats and grab bars. The ADU has one (1) bathroom inside and another bathroom on the side.

Medications were kept in a locked pantry on the left-hand side of the kitchen locked and inaccessible to the residents. All medications were properly labeled. The first aid kit and the files are kept also in this pantry.

LIC809C-continued

SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina SaucedoTELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:
DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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
VISIT DATE: 08/07/2024
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Kitchen Area: LPA inspected the kitchen area. There is one (1) refrigerator which was clean and in good operation in this area. LPA observed sufficient supply of seven (7) day non-perishable and perishable foods in the cabinets. The knives/sharps are in the kitchen on your left-hand side, inaccessible to the residents. There is a pantry area full of non-perishables. The telephone line is on the counter. There is one (1) fire extinguisher fully charged.

Outside: LPA toured the outside area. LPA observed a covered shaded area for residents and appropriate outdoor furniture. The facility has no body of water on the premises. There is one gate that is unlocked leading to the outside area towards the street. There is a shed at the entrance of the facility on your left-hand side next to a large barbecue grill.

The washer and dryer are located inside a closed door next to the kitchen area leading to the upstairs. The chemicals are in this area inaccessible to the residents.

The carbon monoxide and the smoke detector were tested, and they were operable, interconnected.

There is a garage outside and a storage area that was converted to an unauthorized ADU with a kitchen and bathroom and on the side of the ADU is two (2) side doors-one (1) is a bathroom and (1) is a washer and dryer room. There is a current building permit that was received 03/28/24. Let it be noted, there has been changes to the original facility sketch. LPA was able to tour and observe the ADU.

There is a signal system for the facility.

Administration: The Liability Insurance was reviewed and will be expire in 12/2024. There are several Covid 19 signs on the wall, hygiene sanitation signs, and the Ombudsman sign against the walls of the facility, YES, Bill of Rights, Facility Sketch, and Personal Rights at the entrance of the facility. The Emergency Disaster Plan and Mitigation Plan were in a binder.

An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to the administrator.

SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina SaucedoTELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
LIC809 (FAS) - (06/04)
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