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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607670
Report Date: 03/14/2024
Date Signed: 03/14/2024 12:33:29 PM


Document Has Been Signed on 03/14/2024 12:33 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 HOMEFACILITY NUMBER:
197607670
ADMINISTRATOR:YOLANDA BERNARDOFACILITY TYPE:
740
ADDRESS:178 WEST 231ST STREETTELEPHONE:
(310) 876-6917
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY:5CENSUS: 4DATE:
03/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:08 AM
MET WITH:Director , Yolanda BernardoTIME COMPLETED:
01:24 PM
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On 03/14/24 Licensing Program Analyst (LPA) Lizeth Villegas conducted an unannounced annual required 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 serve two (2) ambulatory, and three (3) bedridden residents ages 60 and above. Fire cleared for two (2) bedridden residents in room #3 with the 3rd approved to be placed in either of the two remaining rooms. Hospice waiver approved for three (3) resident. Liability insurance active, annual fees are current, land line observed.

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. Resident bedrooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Bathroom toilets and water faucets worked properly, shower was free of mold/mildew, and there are sufficient toiletries accessible to residents. The water temperature properly measured between 105-120 F.. A supply of perishable and non-perishable food was observed, toxins and knifes were stored and inaccessible to residents, no weapons nor bodies of water on the premises, exits and walkways are free of debris/hazards.

LPA conducted a records review of 2 staff records, 2 resident records, and 2 medication administration records, no discrepancies observed. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. The last fire was conducted on 02/26/24, 1 fire extinguisher fully charged, carbon monoxide and smoke detectors are interconnected and operational. Auditory alarms were observed. No deficiencies observed during visit.

Exit interview conducted with Director Yolanda Bernardo, and a copy of this report was provided.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Lizeth VillegasTELEPHONE: (818) 391-9974
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2024
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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