306006813-12-30-2025-22-AS-EBEY-DPUQ4W-20251230105101

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006813
Report Date: 12/30/2025
Date Signed: 12/30/2025 10:51:22 AM

Document Has Been Signed on 12/30/2025 10:51 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	PARADISE GARDEN GUEST HOME		FACILITY NUMBER:	306006813
ADMINISTRATOR/ DIRECTOR:	MARICA, ABEL		FACILITY TYPE:	740
ADDRESS:	9636 RINDGE CIRCLE		TELEPHONE:	(949) 395-0090
CITY:	FOUNTAIN VALLEY	STATE: CA	ZIP CODE:	92708
CAPACITY: 6		CENSUS: 0	DATE:	12/30/2025
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:00 AM
MET WITH:	Abel Marica - Applicant/Adminiostrator		TIME VISIT/ INSPECTION COMPLETED:	11:00 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On December 30, 2025, at 8:00am, Licensing Program Analyst (LPA) Eboni Bentley arrived announced for the purpose of conducting the Pre-Licensing visit for an Initial Application. LPA conducted the visit with Applicant/Administrator Abel Marica, Assistant Mylene Manze, and Maintenance Director Marco Ramirez. The initial application to operate a Residential Care Facility for the Elderly (RCFE) was received by the Department of Social Services on June 30, 2025, for age range 60 and older, with Fire Clearance approved for five (5) non-ambulatory residents and one(1) Bedridden resident. LPA toured the facility's indoor and outdoor physical plant with Applicant Abel Marica. The following were observed: Structure: The facility is a single-story property in a residential neighborhood comprised of four resident bedrooms, four full bathrooms and a half bath, an office and staff room, and an attached two car garage that may only be used as garage. LPA observed all common areas which include the living room, dining area, and kitchen. Telephone Number: The facility currently has a land line with the number (657)232-0487. CONTINUE TO LIC809-C ....

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Eboni Bentley
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: PARADISE GARDEN GUEST HOME	FACILITY NUMBER: 306006813
	VISIT DATE: 12/30/2025

NARRATIVE

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Emergency Phone Numbers/Exit Plan:
Posted in the entry way.

Postings:
The See Something, Say Something (PUB475) was not posted. A receipt for the correct size poster dated December 11, 2025, was provided. All other required posting were available the entry way.

Food Service and Menu:
Supply of seven-day non-perishable and two-day perishables were observed in the kitchen. The emergency food/water supply were also available in the office. LPA observed the Activity Schedule and Food Menu posted.

Smoke and Carbon Monoxide Detectors:
The smoke detectors and carbon monoxide alert systems were tested and found operational.

Fire Extinguishers:
Two fire extinguishers were mounted, fully charged, and serviced on August 4, 2025.

Fire Clearance:
Approved on August 27, 2025, for five (5) non-ambulatory residents and 1 Bedridden resident.

Signal System:
The facility does not signal system.

Bedrooms:
The resident bedrooms had all required components, are spacious, and easily accommodate the residents’ furnishings. All rooms and closets contained space for residents’ personal items and belongings.

CONTINUE TO LIC809-C ....

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Eboni Bentley
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025

LIC809 (FAS) - (06/04)

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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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: PARADISE GARDEN GUEST HOME	FACILITY NUMBER: 306006813
	VISIT DATE: 12/30/2025

NARRATIVE

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Bathrooms:
Bathrooms were clean, however sinks do not indicate hot/cold settings, Bathroom #1 does not have a grab bar inside shower, Half-Bathroom does not have grab bar near toilet, and Bathroom #5 has a shower spout that is damaged and needs to be replaced.

Water Temperature:
The water temperature in the four resident bathrooms measured at 113.9 and 117.5 degrees Fahrenheit.

Linens and Hygiene Supplies:
Clean linens and hygiene supplies for resident use were fully stocked.

Appliances:
Stove burners, microwaves, refrigerator, freezer, and washer/dryer were inspected and operating.

Resident and Staff Files:
Resident and staff records will be maintained on site.

Medication:
Medication will be secured in a closet near the kitchen.

Reading Material, Games, Equipment, & Materials:
Games and activities were not available.

Sharps and Toxins:
Sharps will be secured in drawer in the kitchen and inaccessible. Cleaning supplies and toxins were observed locked.

Medications, First Aid Kit, & Manual:
The First Aid Kit was checked and missing a thermometer.

CONTINUE TO LIC809-C ..

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Eboni Bentley
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025

LIC809 (FAS) - (06/04)

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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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: PARADISE GARDEN GUEST HOME	FACILITY NUMBER: 306006813
	VISIT DATE: 12/30/2025

NARRATIVE

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Liability Insurance:
Facility does not currently have liability insurance. A proposal for liability insurance protection was observed.

Component III is waived due to the applicant fulfilling the requirements previously for existing facilities.

The following items requiring correction:
· Repair and install window screens on all windows
· Repair water damage in Staff Room/Office, below window, ensure no ants
· Ensure faucets in all bathrooms clearly indicate hot and cold settings.
· Install grab bars Hallway Bathroom and Bathroom#1
· Repair shower water spout in Bathroom #5
· Provide games and activities for residents use
· Install night lights in hallway
· Ensure First Aid Kit has a working thermometer
· Provide a Teleconference Device for residents’ use
· Ensure all emergency supplies which include but are not limited to whistles, cooler, and more are obtained per the Emergency Disaster Plan (LIC610E)
· Amend the LIC610E reflecting the type of residents served
· Missing postings - The See Something, Say Something (PUB475)
· Submit proof of liability insurance policy

Based on today’s observation, the facility is not ready for licensure. A subsequent visit will be conducted to review the corrections on January 15, 2026 and Applicant will contact the department if an extension is needed.

An exit interview was conducted with Applicant Abel Marcia and staff, and a copy of this report was provided at the end of the visit.

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Eboni Bentley
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025

LIC809 (FAS) - (06/04)

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