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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602382
Report Date: 04/30/2024
Date Signed: 04/30/2024 04:08:55 PM

Document Has Been Signed on 04/30/2024 04:08 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:PARADISE HOME CAREFACILITY NUMBER:
374602382
ADMINISTRATOR/
DIRECTOR:		INOCENCIO, REMEDIOSFACILITY TYPE:
740
ADDRESS:4478 SAN JOAQUIN STREETTELEPHONE:
(760) 754-2774
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY: 6CENSUS: DATE:
04/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:40 PM
MET WITH:Administrator Remedios "Remy" InocencioTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced case management visit to conduct follow up regarding a self-reported incident report. LPA was greeted by, identified herself to, and explained the purpose of the visit to Administrator Remedios "Remy" Inocencio.

On 3/29/2024, the Department received a self reported incident report dated 3/28/2024 that described that on 3/18/2024, Resident 1 (R1) had eloped from the facility without staff supervision and returned the same day.

During today's visit, LPA observed residents in care, conducted a welfare check, reviewed facility records, and interviewed residents and staff. Additional follow up is required and will be completed on a subsequent visit.

No deficiencies were cited on today's date. An exit interview was conducted with Administrator Remedios "Remy" Inocencio, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/30/2024
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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