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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610199
Report Date: 01/07/2022
Date Signed: 01/07/2022 12:38:43 PM

Document Has Been Signed on 01/07/2022 12:38 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:A PARADISE VILLAFACILITY NUMBER:
197610199
ADMINISTRATOR:HAKOBYAN, ANNAFACILITY TYPE:
740
ADDRESS:9925 COLLETT AVE.TELEPHONE:
(818) 919-5595
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 6CENSUS: DATE:
01/07/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Anna Hakobyan TIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Pitz conducted a scheduled prelicensing visit on this day.

LPA arrived at the facility and was greeted by administrator Anna Hakobyan. LPA utilized the RCFE Prelicensing Inspection tool to review all eleven inspection domains. The following issues to be corrected were identified:


-Please provide a photo of the closet in Bedroom #3 being cleared out of storage items.



Component III was conducted during the visit.

This report will be sent to the Centralized Application Bureau (CAB) You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB analyst. Failure to comply could affect approval of your license.


Report reviewed, signed and delivered. Exit interview conducted.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Alexander Pitz
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2022
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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