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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206732
Report Date: 06/27/2022
Date Signed: 06/28/2022 08:23:40 AM

Document Has Been Signed on 06/28/2022 08:23 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:PARADISE GARDENSFACILITY NUMBER:
157206732
ADMINISTRATOR:DIANA ELLISFACILITY TYPE:
740
ADDRESS:15318 LILA ROSE CT.TELEPHONE:
(661) 829-1531
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 6CENSUS: 6DATE:
06/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:54 AM
MET WITH:Staff Bobbie ArnoldTIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analyst LPA Shawna Doucette conducted an Annual Inspection on this date. LPA was met by Staff Bobbie Arnold and discussed the purpose of the visit. LPA and Staff Bobbie Arnold began the tour at the front entrance of the facility. LPA contacted Licensee via telephone who advised the facility does not have an Administrator at this time due to the Administrator's certificate expiring 3/22. Facility does not have a mitigation plan and Licensee agrees to submit an LIC 808 to CCLD.

Visitor log-in/temperature check, masks, and disinfection station was observed upon entry. Facility has one entrance/exit point. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common areas. Hand washing and other various Covid-19 related signs were observed in the common areas.

LPA observed a two day supply of perishable food and seven day supply of non-perishable food. Cleaning supplies were observed to be on the garage floor not locked and accessible to residents in care. Facility does not have personal protective equipment at the facility. Staff advised the Licensee has all of the PPE off site.

Resident’s files have updated emergency contact information.


Exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2022
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 06/28/2022 08:23 AM - It Cannot Be Edited


Created By: Shawna Doucette On 06/27/2022 at 10:59 AM
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
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: PARADISE GARDENS
FACILITY NUMBER: 157206732

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/28/2022
Section Cited

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Storage Space (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requrement was not met as evidenced by Licensee did not have cleaning supplies locked
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and were accessible to residents in care. Based on observation cleaning supplies were not locked and were accessible to residents in care on the garage floor which poses an immediate health and safety or personal rights risk to residents in care.
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Type B
07/27/2022
Section Cited

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87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in
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responsibilities when the need for such additional hours is substantiated by written documentation. This requirement was not met as evidenced by Based on interviews and records review the facility does not have a certified Administrator which poses a potential health safety and personal rights risk.
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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:Sergiy Pidgirny
LICENSING EVALUATOR NAME:Shawna Doucette
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2022


LIC809 (FAS) - (06/04)
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