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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609982
Report Date: 08/12/2021
Date Signed: 08/12/2021 04:20:23 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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:PARADISE IN THE VALLEY LLCFACILITY NUMBER:
197609982
ADMINISTRATOR:COHEN, YEHUDAFACILITY TYPE:
740
ADDRESS:13530 SHERMAN WAYTELEPHONE:
(323) 806-0786
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY:46CENSUS: 23DATE:
08/12/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Yehuda Cohen, AdministratorTIME COMPLETED:
04:16 PM
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Licensing Program Analyst (LPA) Salia Walker arrived unannounced to conduct a joint Case Management- Incident visit in lieu of COVID-19 Positive outbreak at the above facility. In attendance included LA County Public Health Nurse Ovsanna Dermenjyan, LA County Physician Specialist Cammy Babaie MD and Administrator Yehuda Cohen. The purpose of the visit had a specific emphasis on infection control practices.


Upon entry, the facility has a central entry point for signing in, symptom screening, and temperature checks. The facility has appropriate signs in the common spaces to promote proper hand hygiene, physical distancing, and symptom reporting. Staff and residents were observed wearing masks throughout the common spaces. Hand sanitizer was available throughout the common spaces for resident and staff use.

During today's visit, a discussion was held regarding the current status of Covid-19 positive residents and staff, testing, communication to staff and families, symptom screening, and adjusted procedures around visitation and excursions. The community is not experiencing any issues with staffing or obtaining Personal Protection Equipment (PPE) at this time. Cleaning and disinfectant protocol is adequate.

No health and safety hazards noted during today's visit. Exit interview conducted. A copy of the report was emailed for signature.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia WalkerTELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021
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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