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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486801837
Report Date: 05/12/2025
Date Signed: 05/12/2025 10:42:23 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/17/2025 and conducted by Evaluator Ali Deniz
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20250317162541
FACILITY NAME:PARADISE VALLEY RESIDENTIAL CARE HOMEFACILITY NUMBER:
486801837
ADMINISTRATOR:GADIA, EDWARDFACILITY TYPE:
740
ADDRESS:524 AMERICANO WAYTELEPHONE:
(707) 344-4744
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:6CENSUS: 6DATE:
05/12/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Licensee, Edgar GadiaTIME COMPLETED:
10:42 AM
ALLEGATION(S):
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Uncleared staff working in the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPAs) Deniz and Cuadra arrived unannounced to conduct a complaint investigation and deliver findings regarding the above allegation and met with Licensee Edgard Gadia.

The Department received an anonymous complaint allegation of uncleared staff working in the facility. Per anonymous complainant, uncleared staff (unknown names) are illegally working as caregivers, but Licensee allegedly hides the illegal employees whenever there is a state visit. On 3/28/25 additional information was received by the Department from an anonymous party that provided names of facility uncleared staff (S1 and S2) who Licensee supposedly rotates their schedules between all three facilities owned by the Licensee. On 3/27/25 and 4/1/2025, LPA conducted visits to the facility made observations, reviewed records and conducted interviews with staff and residents. During tour of the facility, LPA observed S1 and S2 providing care and supervision to residents in care. LPAs inspected a large recreational vehicle (RV) parked outside of the facility where there was no evidence of any personal belongings.

Continued on LIC9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 21-AS-20250317162541
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: PARADISE VALLEY RESIDENTIAL CARE HOME
FACILITY NUMBER: 486801837
VISIT DATE: 05/12/2025
NARRATIVE
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Continued from LIC9099-C...

Based on interviews conducted with Licensee, RV is used as personal for leisure activities. Interviews with staff (S1 and S2) indicates that they are live-in staff who resides in caregiver’s room #8 as indicated in their fire clearance. Based on records review, the facility provided LPA with LIC500 Personnel report dated 3/6/2025 revealed that S1 was listed in the facility schedule. However, during file review, it was revealed that S1 was cleared, but they were not associated to the facility, LPA informed Licensee that S1 should never be working and providing care to residents prior to a criminal record clearance or exemption. The Licensee immediately discovered that there was a discrepancy in the name of S1, so they submitted appropriate correction request to properly associate S1 to the facility roster through Guardian system. On 3/30/2025, the Licensee submitted updated Guardian Roster confirming that after corrections made, S1 was associated to the facility as of 3/6/25. The preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is cited on the attached LIC 9099D. Appeal Rights Given. Civil penalties are being assessed in the amount of $100 for allowing a person to work, reside or volunteer in the facility without a been associated to the facility.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 21-AS-20250317162541
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: PARADISE VALLEY RESIDENTIAL CARE HOME
FACILITY NUMBER: 486801837
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/13/2025
Section Cited
CCR
87355(e)
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Type A - 87355 (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility. This requirement is not met as evidenced by:
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Licensee immediately submitted documentation to associate S1 in the Guardian system and submitted proof of doing so the same day. Deficiency is cleared.
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Based on record review, the licensee did not comply with the section cited above in that one staff (S2) was not associated to the facility in Guardian which poses an immediate health, safety or personal rights risk to persons in care.
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Civil penalties are being assessed in the amount of $100 for allowing a person to work, reside or volunteer in the facility without a been associated to the facility.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/17/2025 and conducted by Evaluator Ali Deniz
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20250317162541

FACILITY NAME:PARADISE VALLEY RESIDENTIAL CARE HOMEFACILITY NUMBER:
486801837
ADMINISTRATOR:GADIA, EDWARDFACILITY TYPE:
740
ADDRESS:524 AMERICANO WAYTELEPHONE:
(707) 344-4744
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:6CENSUS: 6DATE:
05/12/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Licensee, Edgar GadiaTIME COMPLETED:
10:42 AM
ALLEGATION(S):
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2
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9
Personal Rights
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPAs) Deniz and Cuadra arrived unannounced to conduct a complaint investigation and deliver findings regarding the above allegation and met with Licensee, Edgar Gadia.

Regarding the allegation of Personal Rights. Per anonymous complainant, uncleared staff (unknown names) are illegally working as caregivers and they are unfit to give care to the residents (unknown names) due to possibly multiple incidents (unknown dates provided) where their grammar is not consistent and difficult to interpret, where a hospice resident (unknown name) has died “out of negligence of these illegal workers”. On 3/28/25 additional information was received by the Department from an anonymous party that stated resident (R2) was diagnosed with MRSA, but proper care is not given by staff (S1 and S2) who are supposedly not trained resulting on putting all residents at risk. On 3/27/25 and 4/1/2025, LPA conducted visits to the facility made observations, reviewed records and conducted interviews with staff and residents.
Continued on LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 21-AS-20250317162541
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: PARADISE VALLEY RESIDENTIAL CARE HOME
FACILITY NUMBER: 486801837
VISIT DATE: 05/12/2025
NARRATIVE
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 Continued from LIC9099...

During tour of the facility, LPA observed a signed on R2’s room door stating the following: “Contact Isolation - standard precautions prior to entering the room: clean hands, gown and gloves – visitors see nurse before entering”. Based on records review, the facility submitted incident report dated 3/30/25 confirming to the Department, R2’s diagnosis along with staff training records dated 3/28/25. Regarding hospice resident who passed away possible due to negligence of staff. Licensee provided LPA with death report of resident (R1) who was receiving hospice services when they passed away on 12/3/24 along with death certificate #5409158 obtained from California Death Registration System indicating that R1’s immediate cause of death was senile degeneration of brain without any other significant condition that could contributed to their death. A finding that the complaint allegation occurs of personal rights is unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5