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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607670
Report Date: 06/18/2025
Date Signed: 06/18/2025 12:10:32 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/15/2025 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 11-AS-20250515083836
FACILITY NAME:A PARADISE ELDERLY HOMEFACILITY NUMBER:
197607670
ADMINISTRATOR:YOLANDA BERNARDOFACILITY TYPE:
740
ADDRESS:178 WEST 231ST STREETTELEPHONE:
(310) 876-6917
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY:5CENSUS: 4DATE:
06/18/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Licensee/Administrator - Yolanda BernardoTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff does not assist resident with toileting.
Staff withholding resident's personal belongings.
Staff are not meeting resident's dietary needs.
Staff do not communicate effectively with resident.
INVESTIGATION FINDINGS:
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This report supersedes the report dated 05/22/2025 and does not change the findings.

On 06/18/2025, Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced continuation complaint investigation visit regarding the allegations listed above. LPA met with Licensee/Administrator, Yolanda Bernardo and the purpose of the visit was explained. LPA was granted entry to the facility.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
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 6
Control Number 11-AS-20250515083836
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: A PARADISE ELDERLY HOME
FACILITY NUMBER: 197607670
VISIT DATE: 06/18/2025
NARRATIVE
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Investigation consisted of the following:

On 05/22/2025, a facility tour was conducted, interviews were conducted, and records were reviewed. The facility tour consisted of R1’s bedroom, garage, kitchen and food supply. Interviews conducted consisted of 3 staff interviews [Staff 1 (S1) to Staff 3 (S3) were interviewed] and 1 resident interview [Resident 1 (R1) was interviewed]. Resident 1’s records were reviewed which consisted of Admission Agreement dated 05/05/2025, Physicians Report dated 05/05/2025, Safeguards for Property Valuables dated 05/05/2025, and other pertinent documents. Facility records were also reviewed such as Register of Facility Residents dated May 2025 and Personnel Report dated 05/22/2025. On 06/17/2025, 3 witnesses were interviewed [Witness 1 (W1) to Witness 3 (W3) were interviewed]. On 06/18/2025, a tour of the kitchen was conducted, food supply was observed, and resident bedrooms were toured.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 11-AS-20250515083836
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: A PARADISE ELDERLY HOME
FACILITY NUMBER: 197607670
VISIT DATE: 06/18/2025
NARRATIVE
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Investigation revealed the following:

Allegation: “Staff does not assist resident with toileting”, it is being alleged that the facility does not assist residents with their toileting needs. Interviews conducted with R1 reveled the following: 1 out of 1 resident denied the allegation. Interviews conducted with S1 to S3 revealed the following: 3 out of 3 staff denied the allegation. Interviews conducted with W1 to W3 revealed the following: 3 out of 3 witnesses denied the allegation. Based on the department’s interviews this allegation 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, therefore the allegation is unsubstantiated.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 11-AS-20250515083836
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: A PARADISE ELDERLY HOME
FACILITY NUMBER: 197607670
VISIT DATE: 06/18/2025
NARRATIVE
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Allegation: “Staff withholding resident's personal belongings”, it is being alleged that the facility does not give residents access to their personal belongings. Interviews conducted with R1 reveled the following: 1 out of 1 resident denied the allegation. Interviews conducted with S1 to S3 revealed the following: 3 out of 3 staff denied the allegation. Interviews conducted with W1 to W3 revealed the following: 3 out of 3 witnesses denied the allegation. Resident 1’s records reviewed revealed the following: Safeguards for Property Valuables (SPV) was signed by R1 and dated 5/5/2025, moreover, the department observed that the property valuables were stored in the garage as stated on the SPV. Observations on 05/22/2025 and 06/18/2025, reveled the following: residents have their personal belongings (i.e. clothing items and personal hygiene items) in their bedrooms and residents have access to their personal belongings. Based on the department’s observations, interviews, and records reviewed this allegation 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, therefore the allegation is unsubstantiated.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6
Control Number 11-AS-20250515083836
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: A PARADISE ELDERLY HOME
FACILITY NUMBER: 197607670
VISIT DATE: 06/18/2025
NARRATIVE
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Allegation: “Staff are not meeting resident's dietary needs”, it is being alleged that residents’ dietary needs are not being meet resulting in frequent blood sugar drops. Interviews conducted with R1 revealed the following: 1 out of 1 resident agreed with allegation, but R1 also explains that the staff tries to provide them with the food they would like to eat. Interviews conducted with S1 to S3 revealed the following: 3 out of 3 staff denied the allegation. Interviews conducted with W1 to W3 revealed the following: 3 out of 3 witnesses denied the allegation. Observations on 05/22/2025 and 06/18/2025, reveled the following: there is enough food in the facility for 2 weeks, and there is meat, vegetables and carbohydrates in the facility. Observations of R1 on 05/22/2025, revealed the following: staff provided R1 with a bowl of vegetables and R1 ate the food that was provided to them. Resident 1’s records reviewed revealed the following: Physicians Report signed and dated 4/1/2025 does not state that R1 has a special diet. Based on the department’s observations, interviews, and records reviewed this allegation 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, therefore the allegation is unsubstantiated.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 11-AS-20250515083836
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: A PARADISE ELDERLY HOME
FACILITY NUMBER: 197607670
VISIT DATE: 06/18/2025
NARRATIVE
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Allegation: “Staff do not communicate effectively with resident”, it is being alleged that residents do not understand staff when they speak to them. Interviews conducted with R1 revealed the following: 1 out of 1 resident agreed with allegation, but R1 also explains that staff attempts to speak to them in a slow manner and that is when R1 is able to understand staff. Interviews conducted with S1 to S3 revealed the following: 3 out of 3 staff denied the allegation. Interviews conducted with W1 to W3 revealed the following: 3 out of 3 witnesses denied the allegation. Observations of interviews conducted with staff on 05/22/2025, revealed the following: the department interviewed staff in English and staff answered questions in English, additionally, the department was able to understand staffs’ answers. Observations of staff interacting with residents on 05/22/2025, revealed the following: the department observed staff speaking with R1, moreover, the department observed staff communicating with residents in care. Based on the department’s observations, interviews, and records reviewed this allegation 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, therefore the allegation is unsubstantiated.

No deficiencies were cited.

An exit interview was conducted, and a copy of this report was left with the Licensee/Administrator, Yolanda Bernardo.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6