197609494-2-1-2024-31-AS-NMAN-D54MSS-20240509095225

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609494
Report Date: 01/30/2024
Date Signed: 02/01/2024 01:38:37 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.ASC, 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
08/16/2023 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20230816103721

FACILITY NAME:	RAYA'S PARADISE, INC.		FACILITY NUMBER:	197609494
ADMINISTRATOR:	GAMBURD, MOTI		FACILITY TYPE:	740
ADDRESS:	846-848 N. SIERRA BONITA AVE.		TELEPHONE:	(323) 800-5373
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	11	CENSUS: 7	DATE:	01/30/2024
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Brian Rosales		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not ensure resident is adequately fed
Staff do not dispense residents’ medication as prescribed
Staff do not treat residents with dignity or respect

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

*** This page was amended to fix a typographical error *** - 02/01/2024 - LPA Reed

At 3:00 p.m. on 01/30/2024, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with Administrator and disclosed the reason for the visit.

To investigate the allegation above, LPA conducted an initial visit on 08/24/2023 and toured the facility at 12:30 p.m. and reviewed pertinent records at 1:00 p.m. including but not limited to the resident list, staff list, admission agreements, physician reports, care notes, and care plans. LPA interviewed Staff #1 (S1) at 12:30 p.m. on 11/16/23, Staff #2 (S2) at 1:00 p.m. on 11/16/23, Staff #3 (S3) at 4:00 p.m. on 01/23/24, Staff #4 (S4) at 4:15 p.m. on 01/23/24, and Staff #5 (S5) at 2:30 p.m. on 01/29/24. LPA conducted a subsequent visit today and toured the facility at 3:00 p.m. and interviewed Resident #1 (R1) at 3:15 p.m.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024

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-20230816103721

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: RAYA'S PARADISE, INC.	FACILITY NUMBER: 197609494
	VISIT DATE: 01/30/2024

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
26
27
28
29
30
31
32

Regarding the allegation ”Staff do not ensure resident is adequately fed” it was alleged Resident #2 (R2) was not fed enough. Review of care notes showed that R2 did not finish their meals at times. Staff interviews revealed R2 refused food that was offered. Staff documented the percentage of the meal R2 ate and supplemented their diet with a nutritional shake. S1 and S2 confirmed that R2 had difficulty with solid foods and staff needed to supplement R2’s diet with nutritional shakes. S3 and S4 mentioned R2’s health declined and enrolled in hospice services. Based on record review and interviews, the facility properly provided food and nutritional shakes to R2, but R2 had difficulty with eating. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation ”Staff do not dispense residents’ medication as prescribed” it was alleged R2 did not receive their medication because it was crushed and mixed into a puree or shake which they did not finish. S3 and S4 stated R2 received their medications in a nutritional shake which was always finished to completion. S5 mentioned they assisted R2 with medications in apple sauce. S5 could not recall R2 ever refusing medication or not taking medication. No medication refusals were noted in R2’s care notes. Based on interviews and record review, the facility properly assisted with R2 taking their medications. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation ”Staff do not treat residents with dignity or respect” it was alleged staff were rude to R1. Interview with R1 revealed they have a good and respectful relationship with staff. R1 said staff were never mean to them. S3, S4, and S5 mentioned R1 was physically and verbally aggressive with staff, but no staff were ever rude or mean to R1. S5 also mentioned staff relationships got better with R1 as R1 got to know staff better. Based on interviews, staff have been courteous to R1 and treated R1 respectfully. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health and safety hazards were observed during this visit.

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

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2