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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609482
Report Date: 12/24/2024
Date Signed: 12/24/2024 02:14:51 PM

Document Has Been Signed on 12/24/2024 02:14 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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:PARAMOUNT SPECIAL HOME CARE CORPORATIONFACILITY NUMBER:
197609482
ADMINISTRATOR/
DIRECTOR:		QUIJANO, LOIDAFACILITY TYPE:
735
ADDRESS:7044 FALLBROOK AVETELEPHONE:
(747) 226-1864
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY: 4CENSUS: 4DATE:
12/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Loida QuijanoTIME VISIT/
INSPECTION COMPLETED:
02:10 PM
NARRATIVE
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At approximately 9:50 a.m. on 12/24/2024, Licensing Program Analysts (LPAs) Nicholas Reed and Nadia Shahbazian conducted an unannounced annual visit. LPAs met with staff and later the administrator and disclosed the reason for the visit. LPA and administrator toured the facility inside and out.

A file review was conducted prior to today’s visit.

The facility was last visited on 09/17/2024 for a complaint visit. It is a single story building with four (04) bedrooms, three (03) bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for four (04) ambulatory residents.

Upon arrival, LPAs observed a maintained front yard with fruit bearing trees and walkways free of debris. Once inside, LPAs observed postings for the facility’s COVID precautions, confidential complaint contacts, personal rights, grievance procedure, house rules, facility sketch, facility license, emergency disaster plan, and weekly menu.

Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. At 10:15 a.m. LPA measured the room temperature to be 70 degrees Fahrenheit. The living room contained leisure activities, exercise equipment, reading materials, puzzles, television, and board games. Two (02) clients were observed relaxing in the living room. A fireplace was appropriately covered. LPA observed a covered patio area with furniture in good condition. A small dog was kept in the back yard. A shed and the garage were both locked and contained tools, extra supplies, extra refrigerators, and hazardous materials. Walkways were free of hazards. The emergency exit was unlocked.

The facility has three (03) bathrooms. All bathrooms contain liquid soap, paper towels, trash cans with a tight fitting lid, and a non-skid mat in the shower. At 10:30 a.m. LPAs measured the water temperature in the shared bathroom to be 106.5 degrees Fahrenheit.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE: DATE: 12/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/24/2024 02:14 PM - It Cannot Be Edited


Created By: Nicholas Reed On 12/24/2024 at 12:36 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: PARAMOUNT SPECIAL HOME CARE CORPORATION
FACILITY NUMBER: 197609482

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80068.5(e)
80068.5 Eviction Procedures
(e) The licensee shall mail or fax to the Department a copy of the 30-day written notice in accordance with (a) above within five days of giving the notice to the client.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in issuing a 30-day eviction notice to Client #1 (C1) which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/03/2025
Plan of Correction
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Licensee has agreed to request an updated IPP for C1 and show proof by the POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Naira Margaryan
LICENSING EVALUATOR NAME:Nicholas Reed
LICENSING EVALUATOR SIGNATURE:
DATE: 12/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/24/2024


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: PARAMOUNT SPECIAL HOME CARE CORPORATION
FACILITY NUMBER: 197609482
VISIT DATE: 12/24/2024
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In the kitchen, LPAs observed an adequate supply of perishable and non-perishable food in the refrigerator, freezer, and pantries. At 10:40 a.m. the refrigerator and freezer temperatures were measured to be 34 and 0 degrees, respectively. The stove hood was clean, and all surfaces were sanitary. Sharps, confidential files, and medications were locked below the counter top. Cleaning solutions and detergents were locked above the washer and dryer near the kitchen. Both appliances were in working order.

At approximately 11:00 a.m. LPAs observed a fully charged fire extinguisher in the kitchen. It was purchased on 02/23/24 with a receipt attached. The facility has four (04) bedrooms. Three (03) are private and one (01) is shared. All bedrooms contained a chair, nightstand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition. Bedroom #2 served as the staff bedroom, and it was locked.

At 11:25 a.m. LPAs tested the smoke and carbon monoxide detector in the hallway to be operational. When tested, two (02) out of two (02) alarms sounded simultaneously. An auditory alarm at the front door was on and operational.

At approximately 12:00 p.m. LPAs reviewed client and personnel files. All files were available for audit and complete. During discussion with Client #1 (C1) at 10:05 a.m. today and the administrator at approximately 12:15 p.m. today, it was revealed that a 30-day eviction was issued to C1 on approximately 10/01/24. The administrator showed the notice to LPAs and notified the Regional Center as well. Since the Department was not notified of the eviction in a timely manner, a deficiency is issued for the violation of California Code and Regulations 80068.5(e) on the corresponding LIC 809-D page.

During today's inspection, no immediate health or safety hazards were observed.

Exit interview conducted. Appeal rights discussed. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2024
LIC809 (FAS) - (06/04)
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