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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850356
Report Date: 09/15/2025
Date Signed: 09/15/2025 02:10:10 PM

Document Has Been Signed on 09/15/2025 02:10 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:PARADISE SENIOR HOMEFACILITY NUMBER:
195850356
ADMINISTRATOR/
DIRECTOR:		DAVTYAN, KNARIKFACILITY TYPE:
740
ADDRESS:7639 ALCOVE AVETELEPHONE:
(818) 601-0013
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY: 6CENSUS: 0DATE:
09/15/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:28 AM
MET WITH:Michael BadalTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 11:28 AM. LPA contacted the facility Administrator Knarik Davtyan. The Administrator stated that they were unable to come to the facility at the time of the visit but stated that Staff #1 (S1) could conduct the annual visit with LPA. The Administrator advised LPA that the facility does not currently have residents.

Beginning at 12:02 PM, the LPA along with S1 toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

KITCHEN: The kitchen was observed to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured cabinet to contain knives and other sharp objects. LPA observed an additional secured cabinet designated to store resident medications.

COMMON AREAS: This includes the living room and entry area. LPA observed the living room to be clean and properly furnished. Auditory alarms on the exit door to the backyard were disabled at the time of the visit. The living room was observed to contain activities for resident use. The entryway was observed to be clean and contained all requires postings. The entryway contains an appropriately screened fireplace and adequate seating. LPA observed the facility hallway to contain a pantry that contained adequate emergency food supplies. The LPA observed two hallway closets to contain extra linens and space for resident storage. LPA observed the fire extinguisher to be fully charged and was serviced on 10/01/2024. Combination smoke and carbon monoxide detectors were tested at 12:22 PM and all were functional at the time of the visit. No fire clearance concerns were observed. Continued on LIC 809C.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2025
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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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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: PARADISE SENIOR HOME
FACILITY NUMBER: 195850356
VISIT DATE: 09/15/2025
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BATHROOMS: There are two (2) bathrooms for resident use. One (1) is a shared resident bathroom and one (1) is a private resident bathroom. Bathrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed in the resident bathrooms and all were secured at the time of the visit. The water temperature was measured in both restrooms at 108.5 degrees Fahrenheit which is in compliance with regulation.

BEDROOMS: There are four (4) total bedrooms in the facility. Two (2) rooms are designated as dual occupancy rooms and two (2) are single occupancy rooms. Bedroom #1 is designated as the bedridden approved room. Resident rooms were observed to be missing resident beds. Resident bedrooms contained all other required furnishings and sufficient lighting. All resident bedrooms were equipped with emergency flashlights.

GARAGE: The garage was observed to be appropriately secured. The garage contains adequate emergency water, a washer and dryer, extra care supplies, and appropriately stored cleaning supplies.

OUTDOOR SPACE: The backyard has patio furniture including shaded tables and chairs for resident use. The facility has clear passageways for emergency exit use. All ramps observed were secured properly and were in good repair.

EMERGENCY DISASTER PLAN: During today's visit LPA reviewed the facility's emergency disaster plan. The facility's policies and procedures are adequate. LPA did not observe when the plan was last reviewed/updated by the facility's Administrator.

Due to the facility having no residents in care no interviews were conducted and no citations were issued. LPA reminded the facility Administrator to notify Community Care Licensing Division (CCLD) upon the acceptance of their first resident.

This report was read to the Administrator via telephone call. The Administrator has designated S1 to sign this report on their behalf. Exit interview conducted and report was issued.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
LIC809 (FAS) - (06/04)
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