197609494-6-24-2021-31-AS-RVAA-C4AR8E-20210624124749

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609494
Report Date: 06/24/2021
Date Signed: 06/24/2021 01:02:00 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	RAYA'S PARADISE, INC.		FACILITY NUMBER:	197609494
ADMINISTRATOR:	GAMBURD, MOTI		FACILITY TYPE:	740
ADDRESS:	846-848 N. SIERRA BONITA AVE.		TELEPHONE:	(323) 851-7515
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	11	CENSUS: 8	DATE:	06/24/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:14 AM
MET WITH:	Ruby Cruz, Administrator		TIME COMPLETED:	12:45 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	Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced Required One (1) year-Infection Control inspection to the facility. LPA met with Administrator Ruby Cruz and explained the reason for the visit. A tour of the physical plant was conducted at 10:14am and the following was noted: There is only one entrance being utilized at the facility, there are required posters posted at the main door. Screening area is located immediately upon entrance. Electronic sign in, hand sanitizer, and hand washing station are available. LPA was screened upon entry. The facility had submitted and approved Mitigation Plan. Signs to wear a mask and other COVID-19 prevention protocol signs were posted outside the door. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the storage room. The facility has nine (9) bedrooms and eleven (11) bathrooms currently occupying eight (8) residents. Two (2) rooms are shared rooms but currently used privately and seven (7) rooms are private rooms. (continued on LIC 809-C

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: (818) 421-5360
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: RAYA'S PARADISE, INC.	FACILITY NUMBER: 197609494
	VISIT DATE: 06/24/2021

NARRATIVE

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Living and dining room furniture were also checked. The living room is neat and clean. The facility maintains a comfortable temperature at 76 degrees. The smoke detectors are hardwired and interconnected and observed to be operational. There is a carbon monoxide detector in the facility. Fire extinguishers are located throughout the facility and were last serviced in June of 2021.

The backyard of the facility has outdoor furniture with a covered umbrella for residents. There is no body of water at the facility.

Laundry area is located adjacent to the kitchen. Both the laundry area and the kitchen are located downstairs and are inaccessible to the residents.

Food Service/Kitchen area was sufficiently stocked with two (2) days of perishable and seven (7) days of non-perishable food.

The residents rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passage ways are lit.

The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the showers and toilets. The hot water temperature was measured at 120 degrees. There was enough clean linen available in the storage closet..

Medications-LPA observed medication cart in the entrance of the facility. It was locked and inaccessible to residents. There were one (1) complete first aid kit .

Exit interview conducted. A copy of this report was issued and signature obtained.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: (818) 421-5360
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021

LIC809 (FAS) - (06/04)

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