197609316-7-8-2022-11-AS-UCOL-CGRQ25-20220728114633

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609316
Report Date: 07/08/2022
Date Signed: 07/08/2022 03:37:35 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/28/2022 and conducted by Evaluator Martessa Brown

COMPLAINT CONTROL NUMBER: 11-AS-20220628143924

FACILITY NAME:	PARADISE		FACILITY NUMBER:	197609316
ADMINISTRATOR:	RAFIA, BAHMAN		FACILITY TYPE:	740
ADDRESS:	1931 PREUSS ROAD		TELEPHONE:	(310) 876-1293
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90034
CAPACITY:	6	CENSUS: 5	DATE:	07/08/2022
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Shimon Bayer and Eillat Nahum		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not give resident their P&I monies

INVESTIGATION FINDINGS:

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On 7/8/22, Licensing Program Analyst (LPA) Martessa Brown conducted an unannounced complaint visit regarding the above allegation. During today’s visit LPA met with Administrators Shimon Bayer and Eillat Nahum and the purpose of the visit was explained.

The investigation consisted of the following: On 7/8/22, LPA Brown obtained the following documents Residents #1-2’s admissions agreements, P&I money ledgers, personnel report LIC 500 and resident roster. LPA conducted interviews with administrators, staff #1-2 and attempted to interview Resident #2.

The investigation revealed the following:

Regarding allegation: Staff did not give resident their P&I monies.

LIC 9099-C is on the next page.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa Brown	TELEPHONE: (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.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20220628143924

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
	VISIT DATE: 07/08/2022

NARRATIVE

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On 7/8/22 LPA Brown conducted a review of resident #1’s P&I monies ledger, showed dates along with payments issued for 2021. Administrator did not have the dates for 2020. Conducted review of resident #2’s P&I monies ledger and was not accurately documented. LPA conducted interviews with administrator and they stated Resident #1 was admitted in 4/2020 was given P&I monies at the beginning of every month. They stated money was handle by Eillat Nahum and staff #1-2. They stated resident #1 was given money and payments was recorded. They also obtained the residents signature and copies were given. Conducted interview with staff #1-2. They stated resident was not withheld p&I money and was given every month. They stated resident #1 received money until last day was there in May of 2021. LPA attempted to interview resident #2, and stated they receive P&I monies but was unable to answer any more questions. There was not enough information to determine if resident #1 was not given P&I monies.

Based on interviews conducted and records review, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted, and a hard copy was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa Brown	TELEPHONE: (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

LIC9099 (FAS) - (06/04)

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