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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610050
Report Date: 04/19/2021
Date Signed: 04/19/2021 02:42:24 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/15/2021 and conducted by Evaluator Patrick Shanahan
COMPLAINT CONTROL NUMBER: 31-AS-20210315132048
FACILITY NAME:PARADISO RANCH RESIDENTIAL CARE INCFACILITY NUMBER:
197610050
ADMINISTRATOR:MURADYAN, TATEVIKFACILITY TYPE:
740
ADDRESS:18960 KESWICK STREETTELEPHONE:
(818) 371-8233
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:6CENSUS: 4DATE:
04/19/2021
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Tatevik MuradyanTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Resident's are locked in facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst's (LPA) Patrick Shanahan and Wendell Smith arrived at the facility in response to the above mentioned allegation at about 9:30 AM. LPA's were able to speak with the facility administrator and residents regarding the allegation.

At 10 am, LPA's did observe that the front door and back door of the facility have a dead bolt that must be locked with a key. There is no way for the residents or staff to open the door without the key. Resident interviews were conducted at about 10:15 am. All residents interviewed, did not know about the lock and stated that they never tried to exit the facility.

Based on LPA's observations and administrators admission, this allegation is deemed to be substantiated at this time.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2021
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/15/2021 and conducted by Evaluator Patrick Shanahan
COMPLAINT CONTROL NUMBER: 31-AS-20210315132048

FACILITY NAME:PARADISO RANCH RESIDENTIAL CARE INCFACILITY NUMBER:
197610050
ADMINISTRATOR:MURADYAN, TATEVIKFACILITY TYPE:
740
ADDRESS:18960 KESWICK STREETTELEPHONE:
(818) 371-8233
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:6CENSUS: 4DATE:
04/19/2021
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Tatevik MuradyanTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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9
Facility did not provide a variety of meals to resident's.
INVESTIGATION FINDINGS:
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Licensing Program Analyst's (LPA) Patrick Shanahan and Wendell Smith arrived at the facility in response to the above mentioned allegation at about 9:30 AM. LPA's were able to speak with the facility administrator and residents regarding the allegation.

LPA's were able to speak to 3 out of the 4 residents who reside at the home. Interviews began at about 10:15 am. All resiedents interviewed stated that the meals are good and that they differ from day to day. LPA's also checked the facility kitchen and food storage during the vist. At about 11 am LPA's observed the food storage and food quantity to be sufficient.

Based on interviews with residents and LPA's observations, this allegation is deemed to be UNSUBSTANTIATED at this time.

Exit interview conducted and report issued
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20210315132048
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: PARADISO RANCH RESIDENTIAL CARE INC
FACILITY NUMBER: 197610050
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/19/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/21/2021
Section Cited
CCR
87705(l)(5)
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The following initial and continuing requirements shall be met for the licensee to lock exterior doors or perimeter fence gates:
(2) The licensee shall ensure that the fire clearance includes approval of locked exterior doors or locked perimeter fence gates. This requirement is not being met as evidenced by
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The administrator agrees to change the locks on the front and back doors of the facility so that the dead bolt can be opened without a key from the inside. A photo will be sent to the LPA as a POC by the POC date of 4/21/21
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LPA observation and administrator confirmation while conducting a tour of the facility and interview conducted with administrator on 4/19/20 which revealed that the front and back doors are locked and can only be opened with a key which poses an immediate health and safety and personal rights violation to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3