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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004242
Report Date: 07/19/2021
Date Signed: 07/19/2021 01:37:57 PM

Document Has Been Signed on 07/19/2021 01:37 PM - 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:A GARDEN OF PARADISE CARE HOMEFACILITY NUMBER:
347004242
ADMINISTRATOR:OKSANA DOLDIERFACILITY TYPE:
740
ADDRESS:7789 SPENCER LANETELEPHONE:
(916) 878-9811
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 5DATE:
07/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Oksana Doldier, licenseeTIME COMPLETED:
01:50 PM
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Community Care Licensing (CCL) staff Mariya Melnichuk and Licensing Program Analyst (LPA) Wolter arrived at the facility unannounced on 07/19/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain, LPA met with administrator, Oksana Doldier and explained the purpose of the visit. Prior to initiating the annual inspection, CCL staff and LPA completed required COVID-19 testing protocols, and self-screened for symptoms of COVID-19. CCL staff and LPA wore the following Personal Protective Equipment (PPE) during today's visit: surgical masks. Administrator took CCL staff and LPA's temperature upon arrival.

CCL staff, LPA and administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, brief inspection of five (5) resident bedrooms, bathroom, garage, backyard, and additional building. In the areas toured no immediate health, safety, or personal rights violations were observed.

LPA and administrator completed the infection control domain together and facility was found to be in substantial compliance at this time.

No deficiencies are being cited as a result of todays inspection.
Exit interview conducted and copy of report left at the facility.

Administrator to send in updated copy of LIC 308 - Designation of Facility Responsibility, LIC 500 - Personnel Report, LIC 999 - Facility Sketch and current copy of Liability Insurance to update facility file to Community Care Licensing by 07/26/2021.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Danyle Wolter
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2021
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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