Paradise Senior Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with staff#1 (S1) and explained the reason for the visit. At approximately 9:50 am, with the assistance of staff, LPA took a tour of the physical plant to ensure the health and safety of the residents are protected and that the physical plant complies with Title 22 Regulations. Required postings were observed in the entry area. The facility is a two-story building. From the first floor, there is a stairwell that leads to the 2nd floor. The stairwell has a door that is being kept locked. On the 2nd floor, there are two bedrooms, each has a bathroom and two balconies. The 2nd floor is furnished. Staff#1 (S1) stated that the 2nd floor is being used by other staff members. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility, properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the kitchen cabinets. The fire extinguisher is located in the kitchen with a purchase date of March 9, 2025. Bedrooms: There were four (4) bedrooms designated for residents' use. Three (3) bedrooms are designated for private use, and one (1) room is shared. All four bedrooms, in use by residents, were properly furnished with appropriate bedding and linens, with sufficient lighting. Bathrooms: There are two (2) bathrooms designated for residents' use. Both bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured from the bathroom sink at 106.8 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Common Areas: These included the living room and dining area. The common areas were properly furnished. The dining room table is large enough to seat the capacity of the facility. Seating such as couches where in good repair and sat the capacity of the facility. (Continue on 809 C) Surrounding Grounds: Entry/exits were free of obstruction. There was a shaded area with furniture appropriate for outdoor use. The outdoor area was free of hazards. The side gate of the home was checked to ensure no locks were installed, and that the exit and passageway are clear for emergency evacuation. Laundry Area/ Garage: The laundry area is located in the garage, which is inaccessible to residents. The garage door is locked. The garage is used only for storage. LPA observed storage boxes and an extra fridge with additional food supplies. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and in compliance with licensing forms. Resident Files: LPA conducted a file review of resident records to ensure compliance with licensing forms. LPA observed that per the Physician Report, Resident#3 (R3) is bedridden. R3 resides in Room#1, which is not cleared for a bedridden resident. LPA reviewed the facility's fire clearance and noted that the facility is approved for 1 resident in Room#4. The facility currently has 2 bedridden residents. Resident 1 is in Room#4, and Resident 3 is in Room #1. LPA advised the Administrator regarding the fire clearance violations. The administrator stated that she will obtain approval for fire clearance for R3 residing in Room#1. Medications: Medications and Medication Records were inconsistent. The administrator was advised to conduct medication audit and provide complete medication records. Exit interview conducted, immediate civil penalty and other citation issued. Copy of this report is delivered.the state’s words, verbatim · CDSS document, Jul 17, 2025

Type of visit: Office

An Informal Conference was conducted today in the Woodland Hills Adult and Senior Care Regional office. The purpose of this meeting was to discuss recent issues of non-compliance. Present at today's meeting is the following: -Eva Miller, Licensing Program Manager (LPM) -Mariana Agban, Licensing Program Analyst (LPA) -Angela Apoyan – Administrator / Licensee The informal conference process was explained to the Licensee. The Licensee was also informed that this Informal Conference is a part of the administrative action process. Further citations may result in a Non-Compliance Conference, which could lead to a referral to the Department's Legal Division for possible license revocation or other administrative actions. BRIEF HISTORY: On 6/18/24 the license for PARADISE SENIOR LIVING-1 – 197608745 was closed and a license issued to PARADISE SENIOR LIVING – 197610439. License 197608745 was forfeited due to a change of ownership of the licensed corporation, “Paradise Senior Living, INC”. The Administrator for PARADISE SENIOR LIVING-1 – 197608745, Angela Apoyan, is the Licensee Representative and Administrator for PARADISE SENIOR LIVING – 197610439. (Continue on 809C) On 01/25/25 LPA Mariana Agban conducted a case management visit at PARADISE SENIOR LIVING – 197610439 for deficiencies discovered during a complaint investigation for PARADISE SENIOR LIVING-1 – 197608745. During the investigation of complaint 31-AS-20250115122223, it was determined that the Licensee/Administrator had rented a bedroom designated for facility staff on the approved facility sketch. The Licensee/Administrator stated that the Landlord had rented the room because no staff were currently living in the facility. The Licensee/Administrator also stated that the tenant might be interested in obtaining employment as a night shift caregiver for the facility. LPA advised the Licensee/Administrator that, by renting a room to a tenant outside of the scope of the license, the Licensee/Administrator had altered the purpose of the facility to that of a Boarding House or Hotel. LPA obtained the identity of the tenant and upon review of the Licensing Information System Personnel Report Summary, determined that the tenant did not have a Criminal Record Clearance properly associated to the facility license. The facility was cited and an immediate civil penalty assessed/ The Licensee/Administrator advised that the tenant would be removed from the facility until such a time as the tenant obtained a Criminal Record Clearance associated to the facility license. During today's meeting, LPM Miller discussed and expressed concerns regarding the health and safety of the residents. LPM advised the Administrator/Licensee of the terms of their facility license and encouraged the Administrator/Licensee to review Title 22 regulations. The Licensee was informed that Community Care Licensing (CCL) shall continue to frequently monitor the facility as often as necessary to ensure the Licensee's compliance with Title 22 Regulations Exit interview conducted, and a copy of the report was given.the state’s words, verbatim · CDSS document, Jan 29, 2025

Type of visit: Case Management - Deficiencies

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 Issuedthe state’s words, verbatim · CDSS document, Jan 21, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Jan 22, 2025

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: 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.the state’s words, verbatim · CDSS document, Jan 21, 2025

Plan of correction: 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.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Mariana Agban conducted a Pre-Licensing Inspection with Administrator Angela Apoyan. A Change in Ownership (CHOW) Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on May 15, 2023. A fire clearance was approved on October 31,2023 for two (2) ambulatory residents, three (3) non ambulatory residents and one (1)bedridden resident, for a total capacity of six. The bedridden fire clearance is for room #4. A dementia plan of operation has been submitted. Hospice waiver has been requested for three (3) residents which is pending approval of Manager. The garage is to be used as a garage only. The smoke alarms and carbon monoxide detector are battery operated and functional. The facility has one fire extinguisher that was purchased on July 11, 2023. The fire extinguisher is located in dining room area. A tour of the physical plant was initiated at approximately 10:20 am and the following was observed: The facility is a two-story building. The facility sketch that was submitted to CCL was just for the first floor. From the first floor, there is a stairwell that leads to the 2nd floor. The stairwell has a door that is being kept locked. On the 2nd floor, there are two bedrooms each has a private bathroom. The 2nd floor is furnished. Administrator stated that the 2nd floor is being used by the landlord. The landlord lives out of the country and once or twice a year comes back to the country. Administrator mentioned that currently future staff live in one of the rooms on the 2nd floor. KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven and sink. There were adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). Knives were observed locked in a kitchen drawer.BEDROOMS: There are four (4) bedrooms designated for residents use. Bedroom #1 and #2 are private rooms for ambulatory residents. Bedrooms #3 and #4 are shared rooms with bedroom #4 having a bedridden fire clearance (per STD 850). The applicant furnished the resident bedrooms with beds, night stand, chairs, dresser, bedding and linen. The bedrooms have sufficient lighting and closet space. (Continue on 809C) BATHROOMS: The facility has two (2) bathrooms for the resident's use. Both bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 109.4 degrees. COMMON AREAS: These included the living room and dining room. The living room was equipped with furniture, a television, tables and chairs. The dining area has a large dining room table to accommodate six (6). There were no visible immediate hazards. GARAGE/LAUNDRY ROOM: The washer and dryer is located in the garage, which is kept locked. The garage is also used as extra storage for non-perishable and emergency food supplies and water. There is another refrigerator in the garage for additional perishable food items. MEDICATIONS: The medications are kept locked in a kitchen cabinet. Resident Files: LPA conducted a file review of random resident records to insure compliance of licensing forms. Resident files are kept locked in the office/workstation area. Staff Files: Staff files are also kept in a locked cabinet in the office/workstation area. OFFICE/STAFF WORKSTATION: There is a staff workstation located at the entrance of the facility. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home were clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. The backyard of the facility has a patio and backyard furniture to accommodate the six (6) residents. The facility backyard has sufficient yard space. In addition to the Pre-Licensing inspection, a Component III power point presentation was also held. Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised and a copy of this report provided.the state’s words, verbatim · CDSS document, May 15, 2024

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 6 COMP II Participants: Licensee/Administrator, Angela Apoyan Interview Method: Telephone interview On 12/18/2023, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Dec 18, 2023