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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609494
Report Date: 12/16/2024
Date Signed: 12/16/2024 02:33:29 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/12/2024 and conducted by Evaluator Raymond Comer
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20241212140953
FACILITY NAME:RAYA'S PARADISE, INC.FACILITY NUMBER:
197609494
ADMINISTRATOR:GAMBURD, MOTIFACILITY TYPE:
740
ADDRESS:846-848 N. SIERRA BONITA AVE.TELEPHONE:
(323) 800-5373
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY:11CENSUS: 8DATE:
12/16/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Brian RosalesTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff are not meeting resident's toileting needs-

Staff did not ensure resident's call button was not in disrepair-

Staff left resident in the bathroom for an extended period of time-
INVESTIGATION FINDINGS:
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At 10:00 am, on 12/16/2024, Licensing Program Analyst, (LPA) Raymond Comer, arrived, unannouced, to initiate a 10 day complaint visit. LPA spoke with Administrator, Brian Rosales, and reason for the visit was disclosed.

At 10:20 am, LPA conducted a physical plant tour; No immediate health and safety risks were observed.

To investigate the allegation(s) above, LPA reviewed relevant records at 10:25 am including, but not limited to, the facility's resident roster, personnel roster, facility maintenance repair ticket log, Resident#1 (R1)'s physician report, and care plan. LPA interviewed Staff between 10:40 am, and 11:25. LPA interviewed Residents between 11:40 am, and 12:20 pm. At 12:25 pm, LPA conducted observations of resident room#1, room#9, and room#2.

[LIC 9099-C Continued]-
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
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 31-AS-20241212140953
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: RAYA'S PARADISE, INC.
FACILITY NUMBER: 197609494
VISIT DATE: 12/16/2024
NARRATIVE
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Allegation: Staff are not meeting resident's toileting needs-
LPA interview with residents revealed the following: Residents confirm they are assisted with showering and toileting tasks in a timely manner by staff. Residents (R2) and (R3) require assistance with clothes/diaper changes and confirm staff have ensured they are clean and changed since there admission. R1's responsible family member (F1) confirms they have not witnessed staff being negligent responding to R1's toileting needs. However, F1 did express a concern about staff response times occasionally taking longer than ten minutes. LPA did not observe any smell of urine, feces, nor any foul odors within the facility.
Therefore, based on LPA records review, interviews and observations, the allegation of Staff not meeting resident toileting needs is deemed Unsubstantiated at this time.

Allegation: Staff did not ensure resident's call button was not in disrepair-
LPA interview with residents revealed the following: Residents state that, when activated, "wrist alert fob" and room call buttons function properly, and that staff respond to activated calls in a timely manner. LPA testing of R1's wrist alert fob, restroom call button, and bedroom call button, found them as working property. Staff responded to activated call buttons within five minutes of activation. LPA review of the facility's repair ticket log found no issues regarding call buttons servicing needs; no witnesses were identified to corroborate the allegation.
Therefore, based on LPA records review, interviews with staff, and residents, the allegation of staff not ensuring R1's call button as not being in disrepair is deemed Unsubstantiated at this time.

Allegation: Staff left resident in the bathroom for an extended period of time-
LPA interview with F1 revealed the following: F1 states that R1 has health challenges which makes it difficult for R1 to accurately assess the passage of time. LPA interview with residents confirm that staff respond to activated call buttons within an average of five to ten minutes. LPA interview with staff confirm their awareness and sensitivity to R1's needs regarding timely call button response. No witnesses were identified to corroborate the allegation.
Therefore, based on LPA interviews with R1's responsible family member, staff, and residents, the allegation of staff leaving resident in the bathroom for an extended period is deemed Unsubstantiated at this time.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2