<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609316
Report Date: 07/08/2022
Date Signed: 07/08/2022 03:36:01 PM


Document Has Been Signed on 07/08/2022 03:36 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754



FACILITY NAME:PARADISEFACILITY NUMBER:
197609316
ADMINISTRATOR:RAFIA, BAHMANFACILITY TYPE:
740
ADDRESS:1931 PREUSS ROADTELEPHONE:
(310) 876-1293
CITY:LOS ANGELESSTATE: CAZIP CODE:
90034
CAPACITY:6CENSUS: 3DATE:
07/08/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Shimmy Bayar and Eillat NahumTIME COMPLETED:
03:40 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 7/8/22, Licensing Program Analysts (LPA) Martessa Brown conducted a case management. LPA was met with above administrators. LPA explained the purpose of todays visit.

LPA reviewed residents #1-2 P&I monies ledgers. Administrator was unable to provide LPA requested dates for R1 P&I for the month of 2020. R2 P&I ledger was not accurately documented.

Deficiency Cited Under California Code of Regulations Title 22, Division 6 Chapter 8 and civil penalties assessed. See attached LIC 809-D An exit interview conducted report and appeal rights given .
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa BrownTELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:
DATE: 07/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2022
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


Document Has Been Signed on 07/08/2022 03:36 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754


FACILITY NAME: PARADISE
FACILITY NUMBER: 197609316

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/15/2022
Section Cited

1
2
3
4
5
6
7
87217 Safeguards for Resident Cash, Personal Property, and Valuables
(g) Each licensee shall maintain adequate safeguards and accurate records of cash resources and valuables entrusted to his care.. (2) Records of residents' cash resources and other valuables entrusted to the licensee for safekeeping shall include a copy ..This requirement was not met as evidence by:
8
9
10
11
12
13
14
Administrator did not have all P&I records for R1 and R2's was not accurately documented.

This poses a potential risk to residents in care.
8
9
10
11
12
13
14

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: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa BrownTELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:
DATE: 07/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2