197607670-2-20-2025-11-AS-PSCT-DE3VKD-20250220153009

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197607670
Report Date: 02/20/2025
Date Signed: 02/20/2025 03:30:15 PM

Document Has Been Signed on 02/20/2025 03:30 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME:	A PARADISE ELDERLY HOME		FACILITY NUMBER:	197607670
ADMINISTRATOR/ DIRECTOR:	YOLANDA BERNARDO		FACILITY TYPE:	740
ADDRESS:	178 WEST 231ST STREET		TELEPHONE:	(310) 876-6917
CITY:	CARSON	STATE: CA	ZIP CODE:	90745
CAPACITY: 5	TOTAL ENROLLED CHILDREN: 0	CENSUS: 4	DATE:	02/20/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:51 PM
MET WITH:	Yolanda Bernardo		TIME VISIT/ INSPECTION COMPLETED:	04:00 PM

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On 02/20/25, at 1:30pm, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced annual required inspection visit using the CARE Inspection Tool. LPA met with the Director, Yolanda Bernardo, and the purpose of today’s visit was explained. The facility is licensed to operate for (5) non-ambulatory residents of which (3) may be bedridden elderly residents ages 60 and above. The facility is approved for (3) hospice residents. None of the residents have Restricted Health Care Conditions and none utilizes postural supports or protective devices. The facilities’ annual fees are current.

The facility is a single-story home and consists of the following: three (3) resident bedrooms, two (2) bathrooms one (1) of which is for residents and one (1) is for visitors and staff, staff working area, living room, kitchen, dining room, attached garage which houses the washer and dryer, an additional refrigerator for extra food storage and an outdoor shaded area.

LPA conducted a records review of four (4) residents records, four (4) staff records, and reviewed the facility disaster plan. All resident & staff records were complete. The facility disaster plan was current and in compliance with Title 22 at the time of visit. The fire/emergency drill was completed on 12/31/24. LPA reviewed (4) Resident Medication Administration Records and did not observe any discrepancies at the time of visit. The facilities administrator certificate was current and expires on 12/2/2026. LPA observed that the facility has current liability insurance which expires on 08/14/2025.

All resident rooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed, walls and floors were clean and in good repair, bed linens, comforters and bath towels were fully stocked. Bathrooms were found to be within Title 22 regulation, toilets and water faucets worked properly, shower was free of mold/mildew, there is adequate lighting, and sufficient toiletries accessible to clients. The water temperature measured between 105-116.6F degrees.

Report Continued On LIC 809-C

Janae Hammond	TELEPHONE: (424) 544-1027
Perry Scott	TELEPHONE: (707) 849-2315
	DATE: 02/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: A PARADISE ELDERLY HOME	FACILITY NUMBER: 197607670
	VISIT DATE: 02/20/2025

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Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Carbon monoxide detector was observed and operational. Smoke detectors were working properly, two (2) fire extinguishers were fully charged, one (1) located and mounted in the hallway and one (1) located in the garage, toxins and knives were locked and inaccessible to clients. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked, first aid manual was up to date. A landline was observed. Outside grounds were toured and no bodies of water were observed. Exits/ Walkways around the home were free of debris and hazards.

During today’s visit no deficiencies were observed.

An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Director, Yolanda Bernardo.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (707) 849-2315
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

LIC809 (FAS) - (06/04)

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