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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157206732
Report Date: 01/26/2024
Date Signed: 01/26/2024 12:38:08 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/20/2023 and conducted by Evaluator Alexandria Walton
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20231020160750
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: 5DATE:
01/26/2024
UNANNOUNCEDTIME BEGAN:
10:43 AM
MET WITH:Administrator, Diana EllisTIME COMPLETED:
10:59 AM
ALLEGATION(S):
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Licensee does not ensure that medications are stored locked and inaccessible to residents
Licensee does not ensure that staff receive medication training
INVESTIGATION FINDINGS:
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On 01/26/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to deliver findings on the above allegations. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Diana Ellis

During the course of this investigation, LPA conducted a facility tour, reviewed records, and interviewed staff. On 10/23/2023, LPA conducted a facility tour. On this date, facility staff were unable to complete the tour with LPA. LPA was granted permission to continue the tour unaccompanied by staff. LPA proceeded to conduct the tour which led to the garage. LPA was able to access the garage and observed the door leading to the garage did not have an operational door chime. LPA exited the facility and opened the refrigerator in the garage and found medication accessible to persons other than employees. LPA received training records for staff listed on the LIC500. Upon review of records, LPA found that 5 out of 9 staff did not have up to date medication training and/or staff did not have medication training recorded. CONTINUED TO 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024
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 5
Control Number 24-AS-20231020160750
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: PARADISE GARDENS
FACILITY NUMBER: 157206732
VISIT DATE: 01/26/2024
NARRATIVE
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Based on observation and record review, the preponderance of evidence standard has been met therefore the allegations: Licensee does not ensure that medications are stored locked and inaccessible to residents and Licensee does not ensure that staff receive medication training, are SUBSTANTIATED.

Deficiencies are being issued in accordance with California Code of Regulations, Title 22, Division 6 on the attached 9099D.

Exit interview conducted and plans for corrections have been reviewed and developed. A copy of this report and appeal rights were discussed and provided to Administrator, Diana Ellis whose signature on this form confirms receipt of this document.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/20/2023 and conducted by Evaluator Alexandria Walton
COMPLAINT CONTROL NUMBER: 24-AS-20231020160750

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: 5DATE:
01/26/2024
UNANNOUNCEDTIME BEGAN:
10:43 AM
MET WITH:Administrator, Diana EllisTIME COMPLETED:
10:59 AM
ALLEGATION(S):
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Licensee does not ensure that residents' dietary needs are met
INVESTIGATION FINDINGS:
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On 01/26/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to deliver findings on the above allegations. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Diana Ellis.

During the course of this investigation, LPA conducted a facility tour, reviewed records, and interviewed staff. The allegation: Licensee does not ensure that resident’s dietary needs are met is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies were issued during this inspection. Exit interview conducted. A copy of this report was discussed and provided to Administrator, Diana Ellis whose signature on this form confirms receipt of this document.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/20/2023 and conducted by Evaluator Alexandria Walton
COMPLAINT CONTROL NUMBER: 24-AS-20231020160750

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: 5DATE:
01/26/2024
UNANNOUNCEDTIME BEGAN:
10:43 AM
MET WITH:Administrator, Diana EllisTIME COMPLETED:
10:59 AM
ALLEGATION(S):
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Licensee does not ensure that delegated staff is on site while absent from the facility
INVESTIGATION FINDINGS:
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On 01/26/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to deliver findings on the above allegations. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Diana Ellis.

During the course of this investigation, LPA conducted a facility tour, reviewed records, and interviewed staff. It was determined during the investigation that the Administrator is present in the facility to manage day-to-day operations in the absence of the Licensee. This agency has investigated the complaint alleging: Licensee does not ensure that delegated staff is on site while absent from the facility. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted. A copy of this report was discussed and provided to Administrator, Diana Ellis whose signature on this form confirms receipt of this document.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 24-AS-20231020160750
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: PARADISE GARDENS
FACILITY NUMBER: 157206732
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/02/2024
Section Cited
HSC
1569.625(b)
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(b) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 10 hours of training within the first four weeks of employment and four hours annually thereafter… This requirement was not met as evidenced by:
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Licensee agrees to write a statement detailing the steps the facility will take to ensure the requirements for section 1569.625 is met, to include the facility’s plan to have the 5 out of compliance staff complete the required medication training.
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Based on record review, the licensee did not ensure that all staff members received annual training. Record reviews revealed that 5 out of 9 staff did not have updated medication training which is a potential health and safety risk to persons in care.
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Type B
02/02/2024
Section Cited
CCR
87465(h)(2)
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87465(h)The following requirements shall apply to medications which are centrally stored: (2)Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication... this requirement was not met as evidenced by:
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Administrator removed the medication from the garage and placed the medication in the medication cabinet preventing access to the medication to persons other than staff. POC Cleared.
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Based on observation, the facility did not comply with section 87465 when medication was found to be accessible to persons other than employees in the refrigerator in the garage, which is an potential health and safety risk to persons in care.
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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.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5