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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602869
Report Date: 08/06/2024
Date Signed: 08/06/2024 10:29:22 AM

Document Has Been Signed on 08/06/2024 10:29 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:CEDARS @ PARADISE VILLAGEFACILITY NUMBER:
374602869
ADMINISTRATOR/
DIRECTOR:		WILLIAM LAWSONFACILITY TYPE:
740
ADDRESS:2740 E 4TH STREETTELEPHONE:
(619) 475-5040
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY: 150CENSUS: 80DATE:
08/06/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:32 AM
MET WITH:Executive Director Zoe RezaTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Alyssa Ramirez conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Senior Executive Director Bill Lawson. Executive Director Zoe Reza later arrived to meet with LPA.

Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office. According to the LIC624: on 6/29/24, Resident #1 (R1) eloped from the facility (left without staff supervision). [See LIC 811 Confidential Names List for a description of R1.] R1 returned to the facility unharmed the same day.
During today’s visit, LPA performed a facility tour / welfare check, collected records, and interviewed staff and client.

According to R1’s latest LIC602 Physician’s Report their doctor determined that R1 is able to safely leave the facility unassisted. Interviews and records showed that Licensee had a written Absentee Notification Plan as part of R1’s record of care, and that staff followed this plan.

No deficiencies were cited for this incident. No deficiencies were observed or cited during today's visit.
An exit interview was conducted with Reza, to whom a copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Alyssa Ramirez
LICENSING EVALUATOR SIGNATURE: DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2024
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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