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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609494
Report Date: 07/21/2025
Date Signed: 07/21/2025 02:14:52 PM

Document Has Been Signed on 07/21/2025 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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:RAYA'S PARADISE, INC.FACILITY NUMBER:
197609494
ADMINISTRATOR/
DIRECTOR:		GAMBURD, MOTIFACILITY TYPE:
740
ADDRESS:846-848 N. SIERRA BONITA AVE.TELEPHONE:
(323) 800-5373
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY: 11CENSUS: 6DATE:
07/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Brian Rosales TIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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On 07/21/25, 10:15 am, Licensing Program Analyst, (LPA) Raymond Comer, conducted an unannounced Annual visit to this facility. LPA met with Administrator, and reason for the visit was disclosed.

Facility is licensed as a one-story residence, with kitchen area at sub-floor level, fire clearance for eleven (11) non-ambulatory, of which, eleven (11) may be bedridden. Hospice waiver for eleven (11). No residents are receiving hospice services at this time. Facility has nine (9) resident bedrooms, and ten (10) bathrooms.

At 10:35 am, LPA conducted a tour of the physical plant with the Administrator and observed the following:

Physical plant: Facility’s main door is the primary entry/exit access. Screening area is located upon entrance. Alarm sensors are present at all exits and require a code to deactivate. Visitor Sign-in sheet, hand sanitizer, gloves and masks are available. Hand washing, and other necessary signage are posted throughout the facility. Room temperature is comfortable; wall thermostat displays a setting of 75.0°F. within the required range. An approved Mitigation and Infection Control plan is on file. Required postings are prominently displayed and observed to be current. Disaster drills were last conducted on 4/01/2025.

Fire Detection/Protection system is present in the facility. Multiple dual-carbon monoxide detector/smoke alarms are installed, hardwired, and interconnected. Fire alarms were tested and function properly. LPA observed One (1) fire extinguisher located in the kitchen area, and one extinguisher located in the main hallway. Both extinguishers show service date: 01/07/2025.

[LIC 809C Continued]

NAME OF LICENSING PROGRAM MANAGER: Eva Miller
NAME OF LICENSING PROGRAM ANALYST: Raymond Comer
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: RAYA'S PARADISE, INC.
FACILITY NUMBER: 197609494
VISIT DATE: 07/21/2025
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Kitchen: LPA observed kitchen as clean, equipped with a functional stove, multiple appliances, with adequate supply of perishables and non-perishable food. Pantry space stores emergency dry food, condiments, and can goods. Food observed as properly labeled and stored. Kitchen cabinets store dishes, plastic, paper goods and utensils. Knives and sharps are secured in a locked drawer and inaccessible to residents.

Medications are stored in a secured medications cart in dining room area and are inaccessible to residents. Medications are listed on a centrally stored medication and destruction record log. A First Aid kit is complete and stored in the medication cabinet.



Laundry area is located in secured room adjacent the main kitchen. Laundry soaps and other cleaning agents are stored and inaccessible to residents. Storage observed to have adequate supply of linen and towels.

Commons: LPA observed all common areas of the facility, including the living room and dining areas, to be clean and organized. Furnishings are in good condition.

Bedrooms are observed as clean with sufficient lighting, properly furnished with bedding, dressers, closets, linens, at least one chair, and night stand.

Bathrooms were observed to be clean and sanitary, with necessary supplies and required safety features. (grab bars, anti-slip floor stripping) Hot water temperature measured at 112°F., within the required range.

Outdoor area observed to have a shaded patio, with table with sufficient seating for the residents. Outdoor furniture observed to be in good condition. All trash cans observed as covered. No bodies of water in the facility.

Resident records: At 12:35 pm, Resident files were reviewed for current IPP, Needs and Services plans, physician report, and admission agreements. Resident records appear as complete and current.



Staff records: Staff files were reviewed. Criminal record clearances, and health screenings were present. Staff are associated to this facility. Staff records appear as complete and current.

There were no immediate health and safety hazards observed at the time of this inspection. Exit interview conducted and a copy of this report was given to facility's Administrator.
NAME OF LICENSING PROGRAM MANAGER: Eva Miller
NAME OF LICENSING PROGRAM ANALYST: Raymond Comer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025
LIC809 (FAS) - (06/04)
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