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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002535
Report Date: 08/31/2022
Date Signed: 08/31/2022 10:26:45 AM

Document Has Been Signed on 08/31/2022 10:26 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, 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: 5DATE:
08/31/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Noemi Figueroa, Licensee/AdministratorTIME COMPLETED:
10:26 AM
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On today's date, Licensing Program Analyst (LPA) Rosie Quiroz made an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit, based upon the deficiency cited in LIC form 809-D on 08/17/2022. LPA was greeted and granted entry into the facility by Licensee/Administrator(L/AD)Noemi Figueroa and explained the reason for the visit.

On today's date, LPA Quiroz interacted with staff and residents. LPA Quiroz conducted facility tour along with L/AD Noemi Figueroa. LPA Quiroz did not observe Resident 1 at the facility. L/AD Noemi Figueroa indicated "Resident 1 was relocated on 8/18/2022 to Skilled Nursing Facility."


*Deficiency cited under Title 22 Regulation: 1569.72(a)(f): Residents requiring skilled nursing or intermediate care; bedridden residents- Has been cleared. Licensee complied with the terms of the POC by POC due date.



An exit interview was conducted with L/AD Noemi Figueroa and a copy of this report, LIC 811-Confidential Names and POC letter were provided at exit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022
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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