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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002535
Report Date: 10/04/2022
Date Signed: 10/04/2022 11:53:41 AM

Document Has Been Signed on 10/04/2022 11:53 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: 6DATE:
10/04/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:59 AM
MET WITH:Clara Lozada, Caregiver and Noemi Figueroa (Via telephone)TIME COMPLETED:
12:07 PM
NARRATIVE
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 On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit to Paradise Residential Home. The purpose of today's visit was to conduct a Health and Safety facility inspection of the residents in care. LPA Quiroz was granted entry into the home and met with Caregiver Clara Lozada. Staff 2 was also present. Upon arrival to the facility, LPA Quiroz called Licensee Noemi Figueroa via telephone. Licensee Figueroa indicated not being able to attend today's facility inspection due to a personal appointment.
The facility is licensed for 6 non-ambulatory residents and has a hospice waiver for 4 residents. Licensee Noemi Figueroa indicated there is currently no current certified Administrator on site. Facility Administrator Braulio Figueroa Administrator's certificate expired on 8/7/2021. LPA Quiroz inquired about certification renewal, Licensee replied "Still haven't renewed it." (SEE LIC 809-D)
On or about 11:14 am LPA Quiroz conducted a tour of the physical plant along with Caregiver Lozada. LPA observed 4 residents in living room area resting and one resident visiting with their family. All resident bedrooms were observed to be within Title 22 regulation. Facility was maintained at a comfortable temperature for the residents in care. Residents appeared to be groomed appropriately and no visible injuries noted.
At 11:34 am LPA Quiroz along with Caregiver Lozada inspected inspected the kitchen, garage area and exterior of premises. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. The exit doors had auditory alarms that were all in working order.
Based on today's facility inspection, deficiency was cited under California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted with Caregiver Lozada, and a copy of this report along with LIC 809-D, the Appeal Rights, LIC 811s were provided at exit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2022
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 10/04/2022 11:53 AM - It Cannot Be Edited


Created By: Rosie Quiroz On 10/04/2022 at 11:18 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
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: PARADISE RESIDENTIAL HOME
FACILITY NUMBER: 306002535

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/07/2022
Section Cited
CCR
87405(a)

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Administrator-Qualifications and Duties
87405(a):All facilities shall have a qualified and currently certified administrator...The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours...This requirement is not met as evidenced by:
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Licensee Noemi Figueroa will read and understand CCR 87405(A) and submit proof of understanding and proof of Administrator training completion for self or AD Braulio Figueroa by POC Due date of 10/7/2022.
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Upon arrival to the facility, LPA Quiroz inquired about current AD Certification on premises. LPA Quiroz called and spoke to Licensee Noemi Figueroa who indicated "I tried taking the test but didn't pass it and AD Braulio Figueroa's hasn't renewed it since 2021." This poses a potential risk to residents 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.
SUPERVISOR'S NAME:Alisa Ortiz
LICENSING EVALUATOR NAME:Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2022


LIC809 (FAS) - (06/04)
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