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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445202851
Report Date: 03/21/2025
Date Signed: 03/21/2025 05:05:15 PM

Document Has Been Signed on 03/21/2025 05:05 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:PARADISE ASSISTED CARE CORPFACILITY NUMBER:
445202851
ADMINISTRATOR/
DIRECTOR:		CHRISTINA RIVASFACILITY TYPE:
740
ADDRESS:2177 17TH AVETELEPHONE:
(831) 475-1386
CITY:SANTA CRUZSTATE: CAZIP CODE:
95062
CAPACITY: 39CENSUS: 18DATE:
03/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Administrator Saaj TIME VISIT/
INSPECTION COMPLETED:
05:05 PM
NARRATIVE
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Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced annual inspection and met with Administrator (ADM) Saaj Kaiyom. LPA stated the purpose of the visit. LPA observed 18 clients and 3 staff during visit.

LPA toured the interior and exterior of the facility with ADM to include the kitchen, resident rooms, dining room, bathrooms, kitchen, back and front of the facility. Facility thermostat temperature display was observed at 72 degrees F. All exit and passageways were free and clear of obstruction.

LPA toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA refrigerator temperature displayed at 31 degrees F and Freezer at 0 degrees F. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care.

Fire extinguishers were last serviced on 3/4/2024 LPA reviewed the facility first aid kit. The facility emergency drill log was reviewed. The facility's last drill was on 1/8/2025.

LPA toured 29 bedrooms. During tour of bedroom 11, LPA observed that the sliding glass door did not open when LPA tried to open door. ADM was also unable to slide door open during inspection. This door is not an emergency exit. LPA advised ADM to have door repaired by maintenance.

Due to time constraints this annual will be continued at a later date.

No deficiencies cited today per California Code of Regulations. An exit interview was conducted with ADM and a copy of this report was provided.
SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2025
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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