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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610617
Report Date: 11/18/2024
Date Signed: 11/18/2024 11:10:44 AM

Document Has Been Signed on 11/18/2024 11:10 AM - 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:A PARADISE ASSISTED HOMEFACILITY NUMBER:
197610617
ADMINISTRATOR/
DIRECTOR:		HAKOBYAN,ANNAFACILITY TYPE:
740
ADDRESS:9927 COLLETT AVETELEPHONE:
(747) 236-4064
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 6CENSUS: 0DATE:
11/18/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:19 AM
MET WITH:Anna Hakobyan- LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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At 9:19am Licensing Program Analysts (LPAs), Leslie Ngo-Castaneda and Nadia Shahbazian conducted an announced pre-Licensing visit to the above facility and met with Licensee Anna Hakobyan.

Fire Clearance was approved on 7/3/2024 for a maximum capacity of six (6) non-ambulatory residents, of which one (1) may be bedridden in bedroom #1; hospice waiver for six (6).

The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. The facility is a single-story building. Today's site visit consisted of team touring the physical plant inside and outside and observed the following:

KITCHEN: The kitchen is equipped with a refrigerator, microwave oven and sink. At 9:30 AM, the team observed adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents.

FIRE EXTINGUISHER was last purchased on 6/22/2024 is located in between the living room and the kitchen. First-aid is complete and new.

BEDROOMS: There are four (4) bedrooms designated for client use. All bedrooms are furnished with beds, dresser and required bedding and linen. Extra linen is available in each bedroom. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were tested and observed to be operational. Facility will have awake staff. Bedroom #1 and bedroom #2 are for private use. Bedroom #3 and bedroom #4 are shared bedroom located at the end of the hallway.



Continue to LIC 809-C
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2024
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: A PARADISE ASSISTED HOME
FACILITY NUMBER: 197610617
VISIT DATE: 11/18/2024
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BATHROOMS: At 9:45AM the team observed two and a half (2.5) bathrooms are clean and in good repair. Properly supplied with toilet papers, soap, and paper towels. The hot water temperature measured between 114.6°F. observed appropriate grab bar and had non-skid mat. Bathroom #1 is located in the hallway beside bedroom #4. Bathroom #2 is located inside bedroom #2 for private use. Hot water for bathroom #2 measured at 109°F. Bathroom #3 is located inside bedroom #1 for private use. Hot water for bathroom #2 measured at 111.1°F

COMMON AREAS: The facility maintains a comfortable temperature at 72°F. The living room and dining appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. Office is located by the entrance, by the living room.

MEDICATION: The medications will be kept in the kitchen cabinet and the team observed the cabinet kept locked and inaccessible to residents in care.

SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. At 9:30 AM they were tested and observed to be operational.


SURROUNDING GROUNDS: In the back of the facility has sufficient yard space. LPAs observed appropriate outdoor furniture, with a covered shaded area for clients. The backyard is fenced. LPA discussed the importance of maintaining the care and supervision to meet the needs of clients. There is a swimming pool in the backyard that is locked and fenced. The driveway, passageway and entrance to the home was clear of obstructions. All entry and exit doors have a functional auditory alert when the doors open.

NO GARAGE – there is only car port. In addition, LPAs observed laundry room is located at the end of the hallway of the facility beside bedroom #3. The washer/dryer appear to be in good condition. Laundry supplies are kept lock and inaccessible when not in use with supervision.

Component III was conducted with the administrator and licensee. Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and be notified by the CAB Analyst when your license has been approved. Exit interview was conducted and with a copy of this report was provided to the Applicant/Administrator.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024
LIC809 (FAS) - (06/04)
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