197610574-10-14-2024-31-AS-ASEA-DA2QF9-20241014120735

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610574
Report Date: 10/14/2024
Date Signed: 10/14/2024 12:08:25 PM

Document Has Been Signed on 10/14/2024 12:08 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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	BLESSED PARADISE		FACILITY NUMBER:	197610574
ADMINISTRATOR/ DIRECTOR:	SARKISIAN, LOUSINE		FACILITY TYPE:	740
ADDRESS:	17438 TULSA STREET		TELEPHONE:	(818) 263-4677
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY: 6		CENSUS: 0	DATE:	10/14/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Lousine Sarkisian		TIME VISIT/ INSPECTION COMPLETED:	12:30 PM

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On 10/14/24, at 09:25am, Licensing Program Analysts (LPAs) Angelica Segovia and Gina Saucedo conducted an announced Pre-licensing visit. LPA Segovia met with Administrator Lousine Sarkisian at 9:30 am.

An application was submitted to Community Care Licensing Division-CCLD on 02/13/2024, Initial license for a Residential Care Facility for the Elderly (RCFE), 60 years and older. The requested capacity is for five (5) non-ambulatory and one (1) bedridden, total of up to six (6) residents and fire clearance was approved on 8/23/2024.

Structure: The facility is a single-story building with four (4) bedrooms and two (2) bathrooms.

Entrance: There is only one (1) entrance being utilized. Required postings such as: Personal Rights of Residents, Rights of Resident by Council, Family Council, Infection Control, Emergency and Disaster Plan, Facility Sketch, Theft and Loss Policy, House Rules, Non-discrimination Policy and YES are posted upon entry.

Toxins, cleaning solutions, and laundry detergents are kept locked in a storage closet aside the entrance door inaccessible to residents.

Living/Dining area: The living room is neat, clean, and organized with sufficient seating for both residents and staff. The dining area is also neat, clean, and organized. Both rooms are properly furnished and in good repair. The facility maintains a comfortable temperature of seventy-four (74) degrees. No firearms observed or will be maintained on the premises.

Resident/staff files: Resident and staff files will be kept aside dinning area in a locked cabinet inaccessible to residents.

LIC809C-continued

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BLESSED PARADISE	FACILITY NUMBER: 197610574
	VISIT DATE: 10/14/2024

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Kitchen: Sufficient supplies of dishes, cups, and silverware located within the kitchen cabinets and drawers. Sharps are stored on the right side of the kitchen locked and inaccessible to the residents. Sufficient supply of food such as: canned goods, bottles of water, cereal were observed. Kitchen appliances are working and are in good repair.

Emergency: Fire extinguisher located upon entrance to the kitchen on the left side and dated 3/29/2024.

Medications: Medication will be stored in a cabinet in the kitchen. Medication storage is equipped with a lock to ensure medications will not be accessible to clients. First-aid kit observed as well. There is a working telephone on the premises.

Bedrooms: The bedrooms are properly furnished with bed, nightstand, applicable lightening, and seating. Window coverings are in good repair, not broken or damaged.

Bathroom: The bathrooms are in proper condition and will be equipped with sufficient personal hygiene for each client. Towels and washcloths will not be shared.

Hallways: Hallway is properly luminated. Extra linens/covers observed in storage cabinet within the passageway.

Laundry: Laundry is located within the hallway. Dryer and washer observed to be in good repair.

Staff room: there is no designated staff room in the facility.

Water Temperature: The water temperature was measured in the bathrooms at 115 Fahrenheit and is within regulations.

LIC809C-continued

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2024

LIC809 (FAS) - (06/04)

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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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BLESSED PARADISE	FACILITY NUMBER: 197610574
	VISIT DATE: 10/14/2024

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Smoke detectors: Dual interconnected smoke detectors and carbon monoxide observed to be working properly and were tested at 11:00 am.

Garage: The garage is located outside separate from the facility and is currently being utilized for storage.

Outside: The outside is clean, free of hazards, and will be properly furnished with sufficient seating. A shaded area for residents was observed as well.

Pool: The pool is located in the backyard fenced, locked, and inaccessible to residents.

Administration: The facility had submitted a Emergency and Disaster Plan For Residential Care Facilities For The Elderly and Infection plan.

The Component III Orientation RCFE was shown/reviewed with the Administrator.

Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved.

Exit interview conducted and copy of this report issued to the administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2024

LIC809 (FAS) - (06/04)

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