306005861-4-21-2022-22-AS-SSAS-CE4UX3-20220504155738

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005861
Report Date: 04/21/2022
Date Signed: 04/21/2022 10:36:21 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/14/2022 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220414091757

FACILITY NAME:	PARADISE RESIDENTIAL SENIOR CARE		FACILITY NUMBER:	306005861
ADMINISTRATOR:	REYES, ROSA ANGELICA		FACILITY TYPE:	740
ADDRESS:	24762 ARGUS ST.		TELEPHONE:	(949) 412-1620
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 5	DATE:	04/21/2022
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Diana Manzano Velasco, Selene Mendez		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Staff member inappropriately handled resident causing bruising.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs), Jessica Cho and Kathrina Chin made an unannounced visit to the facility for the purpose of a complaint investigation. LPAs met with Diana Manzano Velasco, Administrator, Johan Mathews, Administrator, Selene Mendez, Caregiver, and Francisco Garcia, Caregiver.

During the investigation, LPAs found that the address was reported in error and occurred at a different facility.

This agency has investigated the complaint and is determined to be UNFOUNDED. LPAs found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. An exit interview was conducted, appeal rights explained and a copy of this report was given to the Selene Mendez, Caregiver.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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