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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002535
Report Date: 02/25/2022
Date Signed: 02/25/2022 02:40:38 PM

Document Has Been Signed on 02/25/2022 02:40 PM - 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:PARADISE RESIDENTIAL HOMEFACILITY NUMBER:
306002535
ADMINISTRATOR:NOEMI FIGUEROAFACILITY TYPE:
740
ADDRESS:546 N. WRIGHTWOOD DRIVETELEPHONE:
(714) 516-2750
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY: 6CENSUS: 4DATE:
02/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Noemi Figueroa TIME COMPLETED:
02:55 PM
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Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced visit to Paradise Residential Home. The purpose of today's visit was to conduct a Required 1 Year inspection. LPA Velazquez was allowed entry into the facility and met with Caregiver Piedad Vazquez. Caregiver Clara Lozada was also present. Noemi Figueroa arrived later to assist with the visit. The facility is licensed for 6 non-ambulatory residents. The facility also has a hospice waiver for 4 residents. There are currently 4 residents living in the facility. The last emergency disaster drill was conducted in November 2021.


At 12:53 PM LPA Velazquez conducted a tour of the physical plant along with Noemi Figueroa. The 2 story home consists of 4 resident bedrooms with 2 bathrooms, living room, den, dining area and kitchen on the first floor. The second floor contains 2 staff bedrooms with 1 staff bathroom. The 4 residents in the facility appeared well-groomed and well cared-for. The resident bedrooms had the required furnishings, bed linens, and closet/drawer space to accommodate each resident comfortably. LPA Velazquez observed a postural support bar on one of the resident beds and full bed rails on another resident bed as well as half bed rails on 2 other resident beds. Per Ms. Figueroa the resident with the full bed rails is not receiving hospice services and written physician's orders were not present in any files of the residents. Ms. Figueroa verified there no written physician's orders were present in the resident files. Resident bath towels and personal hygiene supplies were adequately stocked. The auditory alarms were in operating condition. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, showers were free of mold/mildew and a non-skid surface or mat was in place. LPA Velazquez tested the hot water temperature in the resident bathrooms and the temperature measured at 126.5 degrees in the left sink and at 121.2 degrees Fahrenheit in the right sink of the first bathroom and at 108.3 degrees Fahrenheit the second bathroom which Ms. Figueroa verified.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Patricia Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: PARADISE RESIDENTIAL HOME
FACILITY NUMBER: 306002535
VISIT DATE: 02/25/2022
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LPA Velazquez inspected the kitchen along with Ms. Figueroa. LPA and Ms. Figueroa observed unlocked medications on the door of the refrigerator which Ms. Figueroa verified. LPA Velazquez instructed Ms. Figueroa to remove the medications immediately and staff removed the medications belonging to deceased residents. Perishable and non-perishable food supply was checked and adequately stocked at the time of the visit. The fire extinguishers were fully charged. The smoke and carbon monoxide detectors were tested and found to be operational. Toxins and sharps were locked and inaccessible to residents. First aid kit was checked and found to be in order. The facility did have a First Aid guide and LPA Velazquez advised Ms. Figueroa to obtain an updated First Aid manual.

LPA Velazquez along with Ms. Figueroa toured the outside grounds. There was shading and sufficient seating for residents. Walkways around the home were clear of hazards and the exit gates were operational. There were no security bars or weapons on the premises.

No resident or staff files were reviewed at the time of this visit. LPA Velazquez informed Ms. Figueroa to ensure a written physician's order for bed rails is present in a resident's file pursuant to Title 22 Regulation Section 87608 Postural Supports. LPA Velazquez also provided a written copy of said regulation at the time of this visit which Ms. Figueroa verified.


Deficiencies cited under California Code of Regulations Title 22, Division 6, Chapter 8. An exit interview was conducted with Noemi Figueroa and a copy of this report along with the appeal rights, the LIC 9102 and a copy of the LIC 9098 were provided at the time of this visit.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Patricia Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022
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Document Has Been Signed on 02/25/2022 02:40 PM - It Cannot Be Edited


Created By: Patricia Velazquez On 02/25/2022 at 02:09 PM
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
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: PARADISE RESIDENTIAL HOME
FACILITY NUMBER: 306002535

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87608(a)(3)

87608(a)(3) Postural Supports. Based on the individual's preadmission appraisal...Postural Supports may be used under the following conditions: A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order.
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in 4 out of 4 residents as they had postural supports with no written physician's order which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/26/2022
Plan of Correction
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Licensee to ensure all residents with bed rails have a written physician's order indicating the need and submit written proof to LPA by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Sheila Santos
LICENSING EVALUATOR NAME:Patricia Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2022


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