374602869-10-30-2023-08-AS-AROS-CX4SKB-20231030135628

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374602869
Report Date: 10/30/2023
Date Signed: 10/30/2023 01:56:39 PM

Document Has Been Signed on 10/30/2023 01:56 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:	CEDARS @ PARADISE VILLAGE		FACILITY NUMBER:	374602869
ADMINISTRATOR:	LONG, NICOLE		FACILITY TYPE:	740
ADDRESS:	2740 E 4TH STREET		TELEPHONE:	(619) 475-5040
CITY:	NATIONAL CITY	STATE: CA	ZIP CODE:	91950
CAPACITY: 150		CENSUS: 88	DATE:	10/30/2023
TYPE OF VISIT:	Required - 1 Year	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Administrator Nicole Long		TIME COMPLETED:	02:05 PM

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	Licensing Program Analysts (LPAs) Amy Rodgers and Juliana Barfield, made an unannounced visit to conduct the required One-Year Inspection to ensure substantial compliance with Title 22 regulations. LPAs Rodgers and Barfield were granted entry into the facility by Exevcutive Director, Nicole Long, after identifying themselves and stating the purpose of the inspection. The facility serves one hundred fifty (150) non-ambulatory elderly residents age sixty (60) and above; of which six (6) may be bedridden and may use designated rooms. There is an approved hospice waiver for six (6). This is a four-story complex, with marked entry and exit door on first floor. Elevators are available for residents to use to access all floors. LPA was accompanied by the Executive Director, Nicole Long during a tour of the facility. Tour was conducted inside and out and included a sample of resident units, the dining area, recreation rooms, and food storage areas. Signal systems are in place and operational. The last disaster drill was conducted in October 2023. PPE supplies are onsite. No bodies of water are on premises. Passageways were free from obstructions. According to Executive Director, Nicole Long, there are no weapons and/or ammunition stored on the premises. All doors were operational. Each resident had clean and sufficient bed linens. All extra linens, towels, and washcloths are all accessible in rooms or in locked hall closet. All residents’ rooms were equipped with required furnishings. Lighting was present in the bedrooms. Residents’ bathrooms were observed to be sanitary and operational. Toilets and showers were equipped with grab bars. Hot water temperature in residents’ bathrooms were compliant. [CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: CEDARS @ PARADISE VILLAGE	FACILITY NUMBER: 374602869
	VISIT DATE: 10/30/2023

NARRATIVE

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[CONTINUED FROM LIC 809]

Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were in working order. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

Facility has a two-day supply of perishable food and a seven-day supply of nonperishable food items. Food supply is replenished frequently by outside vendors. Food was observed to be properly stored and labeled. There is an emergency supply of drinking water. Food menus and activities schedule were posted. Chemicals and cleaning supplies were stored in a locked closed room. Medications were labeled, as required, and stored in locked areas.

Staff records review verified that all staff records are complete and compliant. All direct care staff have First Aid certificates and First Aide/CPR certificates, and staff training .Resident records reviewed and confirmed compliant. Administrator’s certification is current.

LPA reviewed the theft and loss policy and procedures. LPAs conducted a thorough review of In-service training procedures. Transportation procedures are compliant. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs.

An exit interview was conducted, this report was discussed with Executive Director, Nicole Long. The report along with Licensee/Appeal Rights (LIC 9058 01/2106), and their signature on this form acknowledges receipt and a copy of the report was given to the by Executive Director, Nicole Long.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

LIC809 (FAS) - (06/04)

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