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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609982
Report Date: 12/09/2020
Date Signed: 12/16/2020 07:30:22 AM

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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:PARADISE IN THE VALLEY LLCFACILITY NUMBER:
197609982
ADMINISTRATOR:COHEN, YEHUDAFACILITY TYPE:
740
ADDRESS:13530 SHERMAN WAYTELEPHONE:
(818) 902-9501
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY:46CENSUS: 0DATE:
12/09/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Yehuda CohenTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Aja Richardson conducted a Prelicensing visit at 10 am and met with the Administrator and Licensee Yehuda Cohen. This is a change of ownership application. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s visit was conducted virtually. This application is for a Residential Care Facility for the Elderly (RCFE) with a capacity of 46. Approved for 36 non ambulatory and 10 bedridden.

At 10 am, a tour of the physical plant was conducted. During the visit LPA observed the following:

KITCHEN: The facility is equipped with a spacious kitchen that is supplied with adequate dining and cook ware. Appliances and fixtures are clean and functional.

BEDROOMS: There are (29) resident rooms consisting of 10 private; 17 shared; 1 that is being used as storage and 1 room is being used an activity room. All bedrooms were supplied with all required bedding and linens. There is sufficient lighting as well as closet and drawer space available. There is no staff room.

BATHROOMS:. Bathrooms are equipped with toilet and shower grab bars. There is sufficient supplies of towels, paper goods and personal hygiene supplies. Hot water delivered ranged between 107.6 to 120.degrees F.

COMMON AREAS: These include a living space and activity room. There is a dedicated area for the posting of required documents during the front entry way.

LAUNDRY ROOM and MED ROOM: There is a laundry room and Med room observed by LPA.


SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Aja RichardsonTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2020
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: PARADISE IN THE VALLEY LLC
FACILITY NUMBER: 197609982
VISIT DATE: 12/09/2020
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SURROUNDING GROUNDS: The property is equipped with furniture appropriate for outdoor use including a covered patio providing shade.

LPA reviewed previous fire inspection conducted on 2/24/2020.

Component III was completed January 2020 and waived by management.



Exit Interview Conducted. Report emailed to Administrator.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Aja RichardsonTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2020
LIC809 (FAS) - (06/04)
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