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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609982
Report Date: 01/13/2023
Date Signed: 01/17/2023 08:06:00 AM


Document Has Been Signed on 01/17/2023 08:06 AM - It Cannot Be Edited

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: 35DATE:
01/13/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Evelyn PenaTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Angel Ascencio conducted a Case Management - Incident Visit to the facility above. LPA met with Wellness Director Evelyn Pena at 10:15 a.m.

This visit was regarding an incident report to Community Care Licensing (CCL) that was received on 12/29/2022, indicating that a staff member has been abusive toward residents. LPA Ascencio spoke to Administrator Yehuda Cohen on 12/30/2022. Administrator added that they received a call from staffing agency manager stating that various staffing agency personnel observed a staff member be verbally and physically abusive towards residents. Administrator added that the staff member in question has been placed on administrative leave pending an internal investigation. Administrator added they are waiting for a written statement from the caregiver agency with additional details. On 01/05/2023, LPA spoke to Administrator regarding the incident. Administrator stated that the staffing agency did provide a written statement but could not provide sufficient information on the dates, times and residents involved. On 1/13/2023, starting at 11: 20 a.m., LPA spoke to staffing agency manager regarding the allegation. Agency manager stated that multiple agency staff members observed a staff member hit residents on the head, violently grab residents, and not thoroughly shower them. Agency manager added that their staff did not want to provide names or dates and times the alleged incidents happened. Later that same day, LPA interviewed four (4) facility staff members beginning at 10:51 a.m.. Interview with staff revealed that staffing agency personnel are providing care in the evening and night. Further interviews revealed that the staff have not observed or heard of any staff being physically or verbally abusive to residents. Staff interviews also revealed that if they were to hear of any misconduct from staff or residents, they would directly notify their manager, community care licensing or the ombudsman office. Interview with six (6) residents, starting at 11:38 a.m. revealed that staff are very pleasant and respectful toward resident. Resident added that they have not observed or heard of any type of abuse within the facility. Lastly, resident feel safe and comfortable around the staff that are currently present at the facility. Based on evidence gathered, there was no citation made during today’s visit. A copy of the report was provided to the Wellness Director and Administrator.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel AscencioTELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023
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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