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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336412122
Report Date: 04/17/2025
Date Signed: 06/26/2025 10:17:34 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/20/2024 and conducted by Evaluator Abdoulaye Zerbo
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20241120160638
FACILITY NAME:PARADISE HOMEFACILITY NUMBER:
336412122
ADMINISTRATOR:AGNES MARTINEZFACILITY TYPE:
740
ADDRESS:34156 ALBACETE AVENUETELEPHONE:
(951) 672-9993
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 6DATE:
04/17/2025
UNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Agnes MartinezTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff interacted inappropriately with a resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted an unannounced visit to the facility to deliver findings on the complaint investigation. LPA Abdoulaye was greeted and granted entrance by Licensee Agnes Martinez. LPA Abdoulaye Zerbo identified himself and discussed the purpose of the visit.
LPA conducted a health and safety check by conducting tour of the facility. No immediate health and safety concerns were observed during the visit.

It was alleged that a staff member interacted inappropriately with a resident. However, interviews with staff revealed that the allegation had been investigated and determined to be false. The Administrator explained R1 is on hospice care and frequently complains about pain. Information obtained revealed R1’s medications were adjusted per physician’s order. Additionally, staff highlighted R1’s inconsistent behavior, such as making calls and hanging up, yelling, or sending incoherent text messages.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Abdoulaye Zerbo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 18-AS-20241120160638
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: PARADISE HOME
FACILITY NUMBER: 336412122
VISIT DATE: 04/17/2025
NARRATIVE
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LPA interviewed S1, who denied all allegations of inappropriate behavior. S1 explained R1 repeatedly removes their oxygen tubing and requests assistance to put it back on, which S1 would accommodate R1 by adjusting the oxygen mask per R1’s request. Interviews with other residents revealed the incident stemmed from R1’s attempts to obtain a controlled substance outside of their prescribed schedule. Additional information obtained from residents’ interview also revealed the allegation never took place and R1 struggles with addiction to controlled substances and frequently requests additional medications outside of their scheduled medication time.

Based on the evidence, the allegation mentioned above is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time.
An exit interview was conducted where this report, LIC9099 was discussed and provided to Licensee Agnes Martinez.

This is an amended version of the original report created on 04-17-25. The findings were clarified and a new 9099 now supersedes it.

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Abdoulaye Zerbo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2