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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604829
Report Date: 08/22/2024
Date Signed: 08/23/2024 09:35:46 AM

Document Has Been Signed on 08/23/2024 09:35 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:PARADISE SENIORS LIVING VALLEYFACILITY NUMBER:
374604829
ADMINISTRATOR/
DIRECTOR:		CARDONA, BRENDAFACILITY TYPE:
740
ADDRESS:8117 JEFFERSON STTELEPHONE:
(619) 750-8488
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY: 4CENSUS: 0DATE:
08/22/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Licensee Brenda CardonaTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
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Licensing Program Analyst (LPA) Amy Rodgers conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted by, identified herself to, and explained the purpose of the visit to Licensee Brenda Cardona.

The facility fire clearance was granted on 06/13/24 and reflected that the facility was approved for 4 non-ambulatory residents aged 60 and above. The facility's fire clearance did not include endorsements for delayed-egress doors or secured perimeter. The submitted facility sketch was consistent with the current layout of the facility.



LPA Rodgers toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were well lit and free of obstruction and slip hazards. Resident bedrooms allowed for easy passage and contained the required furnishings. Toilets, sinks, and showers were in working order.

During today’s visit, LPA, accompanied by Licensee Brenda Cardona, checked Hot water temperature at taps accessible to residents were also compliant: Bathroom #1 sink was 113 F, Bathroom #2 sink was 113.0 F The facility’s ambient internal temperature was complaint at 75 degrees..

The facility has enough linens, hygiene supplies, cooking and dining supplies, and perishable and non-perishable food for future resident use. All kitchen appliances were in working order.

The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. The facility has locked areas for storage of sharp objects, medication, and confidential resident and staff records. (CONTINUED ON LIC 809-C, NEXT PAGE)

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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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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: PARADISE SENIORS LIVING VALLEY
FACILITY NUMBER: 374604829
VISIT DATE: 08/22/2024
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(CONTINUED FROM LIC 809)

No bodies of water were observed at the facility. There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Per Licensee Cardona, no firearms or ammunition are or will be stored at the facility.

Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. All fire extinguisher(s) were serviced within the last twelve months. A complete first aid kit was present. Required licensing postings were observed in visible areas of the facility.


The items reviewed were complaint with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. The applicant passed the pre-licensing inspection.

LPA also reviewed the Component III Training with Cardona on 08/22/24. Cardona was advised that the facility’s application is pending management final review and approval.

An exit interview was conducted with Cardona, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
LIC809 (FAS) - (06/04)
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