197607670-5-22-2025-11-AS-UCOL-DJWQA6-20250725115921

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607670
Report Date: 05/22/2025
Date Signed: 05/22/2025 04:35:24 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/15/2025 and conducted by Evaluator Socorro Leandro

COMPLAINT CONTROL NUMBER: 11-AS-20250515083836

FACILITY NAME:	A PARADISE ELDERLY HOME		FACILITY NUMBER:	197607670
ADMINISTRATOR:	YOLANDA BERNARDO		FACILITY TYPE:	740
ADDRESS:	178 WEST 231ST STREET		TELEPHONE:	(310) 876-6917
CITY:	CARSON	STATE: CA	ZIP CODE:	90745
CAPACITY:	5	CENSUS: 5	DATE:	05/22/2025
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Licensee/Administrator - Yolanda Bernardo		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

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Staff does not assist resident with toileting.
Staff withholding resident's personal belongings.
Staff are not meeting resident's dietary needs.
Staff do not communicate effectively with resident.

INVESTIGATION FINDINGS:

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On 5/22/2024 at around 10:30 AM, Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced complaint investigation visit regarding the allegations listed above. LPA met with Licensee/Administrator, Yolanda Bernardo and the purpose of the visit was explained. LPA was granted entry to the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025

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 11-AS-20250515083836

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: A PARADISE ELDERLY HOME	FACILITY NUMBER: 197607670
	VISIT DATE: 05/22/2025

NARRATIVE

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Investigation consisted of the following:

On 5/22/2025, a facility tour was conducted, interviews were conducted, and records were reviewed. The facility tour consisted of R1’s bedroom and garage. Interviews conducted consisted of 3 staff interviews [Staff 1 (S1) to Staff 3 (S3) were interviewed] and 1 resident interview [Resident 1 (R1) was interviewed]. Resident 1’s records were reviewed which consisted of Admission Agreement dated 5/5/2025, Physicians Report dated 5/5/2025, Safeguards for Property Valuables dated 5/5/2025, and other pertinent documents. Facility records were also reviewed such as Register of Facility Residents dated May 2025 and Personnel Report dated 5/22/2025.

Investigation revealed the following:

Allegation: “Staff does not assist resident with toileting”, it is being alleged that the facility does not assist R1 with their toileting needs. Interviews conducted with R1 reveled the following: 1 out 1 resident denied the allegation. Interviews conducted with S1 to S3 revealed the following: 3 out 3 staff denied the allegation. Based on the department’s interviews this allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20250515083836

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: A PARADISE ELDERLY HOME	FACILITY NUMBER: 197607670
	VISIT DATE: 05/22/2025

NARRATIVE

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Allegation: “Staff withholding resident's personal belongings”, it is being alleged that the facility is withholding R1’s personal belongings. Interviews conducted with R1 reveled the following: 1 out 1 resident denied the allegation. Interviews conducted with S1 to S3 revealed the following: 3 out 3 staff denied the allegation. Resident 1’s records reviewed revealed the following: Safeguards for Property Valuables (SPV) was signed by R1 and dated 5/5/2025, moreover, the department observed that the property valuables were stored in the garage as stated on the SPV. Based on the department’s interviews and records reviewed this allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Allegation: “Staff are not meeting resident's dietary needs”, it is being alleged that the facility does not meet the dietary needs (special diet) of R1. Interviews conducted with R1 revealed the following: 1 out 1 resident agreed with allegation, but R1 also explains that the staff tries to provide them with the food they would like to eat. Interviews conducted with S1 to S3 revealed the following: 3 out 3 staff denied the allegation. Resident 1’s records reviewed revealed the following: Physicians Report signed and dated 4/1/2025 does not state that R1 has a special diet. Based on the department’s interviews and records reviewed this allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20250515083836

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: A PARADISE ELDERLY HOME	FACILITY NUMBER: 197607670
	VISIT DATE: 05/22/2025

NARRATIVE

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Allegation: “Staff do not communicate effectively with resident”, it is being alleged that R1 does not understand staff when they speak to them. Interviews conducted with R1 revealed the following: 1 out 1 resident agreed with allegation, but R1 also explains that staff attempts to speak to them in a slow manner and that is when R1 is able to understand staff. Interviews conducted with S1 to S3 revealed the following: 3 out 3 staff denied the allegation. Observations of interviews conducted with staff revealed the following: the department interviewed staff in English and staff answered questions in English, additionally, the department was able to understand staffs’ answers. Based on the department’s interviews and records reviewed this allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies were cited.

An exit interview was conducted, and a copy of this report was left with the Licensee/Administrator, Yolanda Bernardo.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025

LIC9099 (FAS) - (06/04)

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