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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200348
Report Date: 10/28/2021
Date Signed: 10/28/2021 01:55:43 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/02/2021 and conducted by Evaluator Lizette Francisco
COMPLAINT CONTROL NUMBER: 15-AS-20210202165901
FACILITY NAME:PARAISO GARDENSFACILITY NUMBER:
079200348
ADMINISTRATOR:BERNADETTE O'SHEAFACILITY TYPE:
740
ADDRESS:217 PARAISO DRIVETELEPHONE:
(925) 838-2184
CITY:DANVILLESTATE: CAZIP CODE:
94526
CAPACITY:6CENSUS: 5DATE:
10/28/2021
UNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Pamela Chan, AdministratorTIME COMPLETED:
02:05 PM
ALLEGATION(S):
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The facility is not allowing visitations.
Facility staffing is not sufficient.
Facility staff are not using PPE.
INVESTIGATION FINDINGS:
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On 10/28/2021 at 12:40pm, Licensing Program Analyst (LPA) L. Francisco arrived unannounced to deliver findings for the above allegations. Upon arrival, LPA was greeted by Care Staff, Jordan Aguinaldo. Administrator, Pamela Chan later arrived at 1:25 PM.

During the course of the investigation, LPA obtained information, interviewed 5 staff and 4 residents. Based on information obtained, the facility is not allowing visitations. However, due to COVID-19, PIN 20-09-CCLD issued guidance for facilities regarding visitation waiver.

It was alleged facility staff is not sufficient. However, based on interviews with 3 of 3 staff and record review, there are 3 staff scheduled during the day shift.

REPORT CONTINUES ON 9099C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Lizette Francisco
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 15-AS-20210202165901
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: PARAISO GARDENS
FACILITY NUMBER: 079200348
VISIT DATE: 10/28/2021
NARRATIVE
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Based on information obtained, facility staff are not using PPE. Interview with 3 of 3 residents revealed they observed staff wearing masks. 4 of 4 staff confirmed they wear masks. However, during their lunch break, staff would remove their mask while their eating.

This agency has investigated the allegations above. We have found that the complaint were UNFOUNDED, meaning that the allegation were false, could not have happened and/or are without a reasonable basis.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Lizette Francisco
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2