445202851-12-29-2025-26-AS-CKAI-DPVQQ8-20251231112154

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 445202851
Report Date: 12/29/2025
Date Signed: 12/29/2025 12:39:29 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/02/2025 and conducted by Evaluator Marcella Tarin

COMPLAINT CONTROL NUMBER: 26-AS-20250102144601

FACILITY NAME:	PARADISE ASSISTED CARE CORP		FACILITY NUMBER:	445202851
ADMINISTRATOR:	CHRISTINA RIVAS		FACILITY TYPE:	740
ADDRESS:	2177 17TH AVE		TELEPHONE:	(831) 475-1386
CITY:	SANTA CRUZ	STATE: CA	ZIP CODE:	95062
CAPACITY:	39	CENSUS: 26	DATE:	12/29/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Licensee/Administrator Lusanta and Saaj Kaiyom		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Facility staff administered controlled medication that is supposed to be administered by a licensed health care professional.
Facility did not seek immediate medical care for resident after fall
Facility water temperature is too cold
Administrator offered medications of a deceased resident to another resident’s family member

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to conduct a complaint investigation visit to deliver the findings. LPA met with Licensee/Administrators Lusanta and Saaj Kaiyom. LPA stated the purpose of the visit.

On 1/2/2025 the Department received a complaint with the above allegations.

On 1/8/2025, 7/11/2025, 8/8/2025, complaint investigations visits were conducted.

It has been alleged that facility staff administered controlled medication that is supposed to be administered by a licensed health care professional.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20250102144601

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 CORP	FACILITY NUMBER: 445202851
	VISIT DATE: 12/29/2025

NARRATIVE

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W1 states medication administration is being done by ‘non-trained’ staff resulting in medication errors and missing syringes. W1 states he/she did not observe these incidents of medication errors and missing syringes and did not provide information regarding these incidents.

On 1/8/2025, 7/11/2025, 8/8/2025, LPAs interviewed 7 Staff (S1 to S7). 5 Out of 7 Staff state he/she has not observed a staff who is not a MedTech in assisting residents with medications. S4 and S7 states he/she has observed staff who are not MedTechs, assisting residents with medications.

LPA reviewed 7 staff training records. 6 Out 7 staff have training for medications.

Facility did not seek immediate medical care for residents after fall
W1 states R1 had a fall on June 20, 2024, and the facility called R1’s family and did not seek medical attention.

On 1/8/2025, 7/11/2025, 8/8/2025, LPAs interviewed S1 to S7. 6 Out of 7 Staff states the facility seeks medical care for residents after a fall. S1 states staff will notify the MedTech and call 911 or palliative care, depending on the situation. S5 states he/she observed R1 fall on 6/20/2024 and the facility did not seek medical attention, instead the facility called the resident’s loved one.

On 8/6/2025 LPA interviewed R1’s Family Member (FM 1). FM 1 states he/she was informed by facility staff that R1 had a fall. FM 1 states R1 fell “due to medication.” FM states he/she does not remember the date of the incident. FM states he/she took R1 to the hospital for assessment and did not have any injuries. FM 1 did not provide additional information regarding this incident.

Facility water temperature is too cold
W1 alleges the facility’s water temperature is ‘too cold’. W1 states the water temperature on the second floor takes more than 15 minutes to get warm, and water temperature on the first floor takes 10 minutes to get warm. W1 did not provide additional information regarding the dates when these incidents occurred.
On 01/08/2025, LPA Madrigal and Marrufo conducted a complaint investigation visit. During visit, LPA Madrigal toured 7 resident bathrooms on the second floor, and 2 resident bathrooms on the first floor.

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SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2025

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20250102144601

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 CORP	FACILITY NUMBER: 445202851
	VISIT DATE: 12/29/2025

NARRATIVE

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LPA Madrigal tested the water temperature in 9 random resident bathrooms sinks. 9 random bathroom sink water temperatures measured from 108 F to 119 F.

Administrator offered medications of a deceased resident to another resident’s family member
W1 alleges he/she observed the facility Administrator offering constipation medication of a deceased resident to another resident’s family. W1 did not provide a date when this incident occurred.

LPA interviewed 7 Staff (S1 to S7). 6 Out of 7 Staff state he/she has not observed the Administrator offering medication of a deceased resident to another resident’s family member. S4 states he/she overheard the Administrator on the phone offering constipation medication of a deceased resident to another resident’s family member. S4 did not provide additional information regarding this incident.

LPA interviewed 7 Family Members (FM2 to FM8). 5 out of 7 FM stated he/she has never been offered the medications of a deceased resident by the Administrator. FM 2 and FM5 declined to be interviewed.

Although the allegations may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was provided.

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2025

LIC9099 (FAS) - (06/04)

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