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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610439
Report Date: 01/21/2025
Date Signed: 01/21/2025 02:07:15 PM

Document Has Been Signed on 01/21/2025 02:07 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:PARADISE SENIOR LIVINGFACILITY NUMBER:
197610439
ADMINISTRATOR/
DIRECTOR:		APOYAN, ANGELAFACILITY TYPE:
740
ADDRESS:8435 AURA AVETELEPHONE:
(747) 202-0457
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 6CENSUS: 5DATE:
01/21/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:41 PM
MET WITH:Angela Akoyan- AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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In conjunction with complaint 31-AS-20250115122223, LPA Mariana Agban conducted a case management deficiencies visit. During the complaint investigation, it was discovered that the Licensee had rented the staff room on the second floor. The administrator stated that the Landlord had rented the room because no staff were currently living in the facility. The administrator also stated that the tenant might be interested in working the night shift as a caregiver at the facility. LPA advised the Administrator that they were operating beyond the terms of their license.

Exit Interview Conducted. An immediate civil penalty cited. Report Issued

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE: DATE: 01/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/21/2025
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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Document Has Been Signed on 01/21/2025 02:07 PM - It Cannot Be Edited


Created By: Mariana Agban On 01/21/2025 at 01:05 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: PARADISE SENIOR LIVING
FACILITY NUMBER: 197610439

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/22/2025
Section Cited
CCR
87355(e)(1)

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Criminal Record Clearance. Prior to working, residing or volunteering in a licensed facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption. This requirement was not met by evidence of:
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The administrator agreed to remove the tenant. An immediate Civil penalty of $500.00 has been assessed. The licensee and administrator will be invited to an informal meeting at the CCL Woodland Hills office.
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Based on the physical plant tour. The Licensee has rented the staff room to a tenant which poses an immediate health, safety, or personal rights risk to persons 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.
SUPERVISOR'S NAME:Eva Miller
LICENSING EVALUATOR NAME:Mariana Agban
LICENSING EVALUATOR SIGNATURE:
DATE: 01/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/21/2025


LIC809 (FAS) - (06/04)
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