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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609316
Report Date: 11/15/2022
Date Signed: 11/15/2022 05:55:22 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
11/08/2022 and conducted by Evaluator Antonia Alvizar
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20221108092804
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: 5DATE:
11/15/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Eilat Nahum, Manager and Shimon Bayar, Administrator TIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Facility staff denied resident food
Facility staff did not change resident's soiled undergarments as often as needed
INVESTIGATION FINDINGS:
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On 11/15/22, Licensing Program Analyst (LPA) Antonia Alvizar conducted an unannounced complaint visit regarding the above allegations. 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 11/15/22, LPA Alvizar obtained the following documents Personnel Report, Resident Roster, Residents #1-2’s Admissions Agreements, Physician Report, ID and Emergency Information, and Unusual Incident Report for R#1. LPA conducted interviews with administrators, staff #1-2. and residents #1-5.



LIC 9099-C is on the next page.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Antonia AlvizarTELEPHONE: (323) 516-4092
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 11-AS-20221108092804
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: 11/15/2022
NARRATIVE
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Continued LIC9099 -C

The investigation consisted of the following: During the course of the investigation staff #1-#4 (S#1-S#4), residents #1-#5 (R#1-R#5) and witness (W#1) were Interviewed. Allegation #1: Facility staff denied resident food. Eilat Nahum, Manager stated, “No, that will never happen this is the residents home". Staff (S#1 – S#2) do not agree with the allegation. S#2 stated, “No, we always give food to residents, first we give them food them fruit”. R#2 stated, “No, they give me food". W#1 stated, " Staff do not hand feed residents".

Allegation #2 Facility staff did not change resident's soiled undergarments as often as needed.


Staff #1-#2 (#1-#2) and residents #1-#5 (R#1-R#5) Eilat Nahum, Manager stated, “No, we have training on how to change resident's soiled undergarments. It is done every two(2) hours or as needed". R#2 stated,
"No, staff change my undergarments they are doing everything they can". W#1 stated, “Resident did not wanted to wear undergarment"

Investigation revealed the following: Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated.


A copy of the Complaint Investigation Report was provided to caregiver, Nurlelawati Ilyas on behalf of Administrator, Shimon Bayar because he had to leave during the course of this investigation.


An exit interview was conducted.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Antonia AlvizarTELEPHONE: (323) 516-4092
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2