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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 11:36:45 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/28/2025 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20250328102443
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, Edward GadiaTIME COMPLETED:
11:35 AM
ALLEGATION(S):
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Questionable death
Facility staff does not seek timely medical treatment
Licensee does not ensure staff are adequately trained
Facility staff are not meeting residents nutritional needs
Facility staff are not providing residents with adequate toileting supplies
Staff are not taking precautions to prevent the spread of illness
Staff are mismanaging resident's records
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Deniz and Cuadra arrived unannounced to conduct a complaint investigation and deliver findings regarding the above allegations and met with Licensee, Edward Gadia.

The Department received anonymous complaint allegation of a questionable death. Per anonymous complainant, there was a resident (unknown name) has died a few months back, proper care is not provided. The Reporting Party could not be contacted to gather additional information regarding the "death" a few months back. Based on LPA’s records review, this allegation had been previously investigated and determined unsubstantiated under complaint# 21-AS-20250317162541, because since December 2024 there was no deceases at this facility, other than a resident (R1) who was under hospice care and their passing was due to unrelated reasons to care and supervision.

Continued on LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
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 4
Control Number 21-AS-20250328102443
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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...

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 questionable death 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.

Regarding the allegation of facility staff does not seek timely medical treatment. Per anonymous complainant and anonymous co-complainant, resident (R2) has a diagnosis of MRSA, R2 is isolated, but proper care is not given by staff (S1 & S2) resulting in R2 getting sick and possible all residents could eventually get sick with MRSA. Based on LPA’s records review, this allegation had been previously investigated and determined unsubstantiated under complaint# 21-AS-20250317162541 due to standards precautions observed at the facility, the incident was self-reported to the Department and staff training records dated 3/28/25 were obtained. A finding that the complaint allegation occurs of facility staff does not seek timely medical treatment 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.

Another allegation was received by the Department about Licensee does not ensure staff are adequately trained. Per anonymous complainant and anonymous co-complainant, all residents at the care home are at risk due to staff providing care are not adequately trained. According to anonymous parties, Licensee rotates all caregivers to three care homes whenever there will be a state visit. The caregivers don't have day off, working 24 hours, which could lead to inappropriate care. Based on LPA’s records review, the facility provided LIC500 personnel report and training records confirming that all staff associated to the facility do have required training hours as stated per regulations. A finding that the complaint allegation occurs of Licensee does not ensure staff are adequately trained 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.

Continued on LIC9099-C...

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
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 4
Control Number 21-AS-20250328102443
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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...There is another allegation of facility staff are not meeting residents’ nutritional needs. Per anonymous complainant, foods of the residents (unknown names) are coming from the relief food stations, residents are not fed on time (Unknown dates and times). LPA was unable to contact reporting party to gather additional information. On 4/1/25, LPA conducted 10-day visit to the facility made observations and requested food receipts for the month of March 2025. During tour of the facility, LPA/staff observed the following in the facility refrigerator: two bags of 6.5lb of chicken thighs, one bag of 5.5 lb of stir fry vegetable blend, one pound of frozen grapes, one bag of ten waffles, one packet of 1.5 lb of ham, eight oranges, one packet of 96 slices of cheddar cheese, two cucumbers, half of tomato, half of purple onion, six apples, one cabbage, five 30gr protein shakes chocolate, two 5.3 oz of zero sugar Greek yogurt, seven 20 oz of bread, 30ct of large eggs, two bottles of 20 oz of juices, 5lb of potato salad, container with eight sprinkled cookies and half gallon of milk. In the pantry there was one watermelon, four bananas, two 8 oz of ensure bottles. In the facility pantry area non-perishables observed were as follow: eight boxes of artificial drink packages, three boxes of jelly, three cans of clam chowder, two boxes of elbow pasta, twelve cans of fruit cocktails, two cans of alfredo sauce, two cans of roast vegetables, five cans of tomato sauce, one can of chicken noodle, one box of 80 oz of quaker oats, one packet of 10lb of pancake mix, six boxes of mac and cheese, two cans of tuna, one can of 16 oz of peanut butter, one box of 24 bottles of ensure and 5lb of cane sugar. Based on interviews conducted with the Licensee, LPA was told that they were expecting their food delivery for that day. On 4/2/25, LPA was provided with order #2000130-23925556 no amount showing, but dated 4/1/25 and delivered to facility address, followed by pictures of food items in the facility refrigerator and pantry area. On 4/23/25, LPA followed up with Licensee to request food receipts requested for the month of March 2025 that confirmed adequate amount of food supplies. A finding that the complaint allegation occurs of facility staff are not meeting residents’ nutritional needs 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.

Regarding allegation of facility staff are not providing residents with adequate toileting supplies. The anonymous complainant reported that most of the time, all supplies are not sufficient referring to incontinence and hygiene supplies. On 4/1/25, LPA conducted 10-day visit to the facility made observations and requested admission agreements as well as pertinent documentation regarding two residents (R3 & R4) who the facility provides supplies for them and documentation about agreement to bring incontinence supplies by the other remaining residents (R5 & R6) or any other document as evidence of this agreement with other agency. Continued on LIC9099-C...

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
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: 3 of 4
Control Number 21-AS-20250328102443
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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 records review, Licensee provided resident’s admission agreements detailing incontinence supplies agreement for R3 & R4 in the amount of $370 for the month of February to March 2025 and other agencies agreements to provide incontinence care supplies. During facility tour of residents’ rooms, LPA observed adequate amount of incontinence supplies in each room. Although, there was adequate amount of incontinence care supplies observed, LPA had a conversation with the Licensee regarding not allowing to have a limited supplies of incontinence care not limited to gloves, shampoo, incontinence briefs, wipes and disposable bed pads. A finding that the complaint allegation occurs of facility staff are not providing residents with adequate toileting supplies 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.

According to anonymous complainant, staff are not taking precautions to prevent the spread of illness. Anonymous complainant raised concerns about the lack of precautions that staff are taking to manage resident (R2) who was recently diagnosed with MRSA. Based on LPA’s records review, this allegation had been previously investigated and determined unsubstantiated under complaint# 21-AS-20250317162541 due to standards precautions observed at the facility, the incident was self-reported to the Department and staff training records dated 3/28/25 were obtained. A finding that the complaint allegation occurs of staff are not taking precautions to prevent the spread of illness 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.

The last allegation refers to staff are mismanaging resident's records. Per anonymous complainant and co-complainant, this is in connection of R2’s case that has been reported and the safety of the elders in Americano. We hope that the State will take action to Licensee's falsification of documents and unjust treatment to the elderly in his care home. LPA has been conducting visits due to multiple complaints received by the Department on 3/27/25 and 4/1/25. Based on records review, the facility has provided pertinent documentation including doctor’s orders and follow up after visits made by residents timely. Resident’s records appeared to be updated and complete as stated per regulation. LPA was unable to contact anonymous complainant to gather specific information regarding supposedly falsification of documents. A finding that the complaint allegation occurs of staff are mismanaging resident's records 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: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
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: 4 of 4