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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347003902
Report Date: 10/06/2021
Date Signed: 10/06/2021 10:49:55 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/20/2021 and conducted by Evaluator Kevin Gould
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20210820073459
FACILITY NAME:PARADISE QUALITY GUEST HOME IIFACILITY NUMBER:
347003902
ADMINISTRATOR:BEATRIZ L. AFALLAFACILITY TYPE:
740
ADDRESS:3432 PAGEANT DIRVETELEPHONE:
(916) 613-7405
CITY:SACRAMENTOSTATE: CAZIP CODE:
95826
CAPACITY:6CENSUS: 5DATE:
10/06/2021
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Beatriz AfallaTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
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8
9
Personal Rights:
1) Resident not being showered
2) Residents needs are not being met
INVESTIGATION FINDINGS:
1
2
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5
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8
9
10
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12
13
Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to the Paradise Quality Guest Home on 10/06/21 at 9:45am to conclude the investigation of the above allegations and to deliver the findings. LPA met with Administrator and together discussed the investigation details.

Based on the interviews and statements obtained during the investigation process, the allegations cannot be substantiated. LPA interviewed RP, R1, R2, R3 and A1, S1 and S2 and received conflicting statements regarding the showering and care needs of R1. LPA also reviewed care records and admission agreements for R1 and did not observe any definitive evidence that would corroborate the allegations. R2 and R3 both stated they were receiving appropriate care and had no complaints of care in the home. Staff interviewed denied the allegations regarding showing and other care needs such as transporting to bathroom.

Report continued on next page. Page 1 of 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
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 27-AS-20210820073459
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: PARADISE QUALITY GUEST HOME II
FACILITY NUMBER: 347003902
VISIT DATE: 10/06/2021
NARRATIVE
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Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of Personal Rights are unsubstantiated but if any additional in formation is received this complaint can be amended and the finding can be changed.

There are no deficiencies noted or cited per California Code Regulation, TITLE 22.

Exit interview was conducted with the facility administrator. Appeal Rights were issued, and a copy of this report was left at the facility.

Page 2 of 2
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2