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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610315
Report Date: 12/13/2022
Date Signed: 12/13/2022 01:42:03 PM

Document Has Been Signed on 12/13/2022 01:42 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:PARADIGM MALIBU PCHFACILITY NUMBER:
197610315
ADMINISTRATOR:BRAMWELL, LUCIAFACILITY TYPE:
772
ADDRESS:27407 PACIFIC COAST HIGHWAYTELEPHONE:
(310) 457-6300
CITY:MALIBUSTATE: CAZIP CODE:
90265
CAPACITY: 6CENSUS: 0DATE:
12/13/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Lucy Nguyen-AdministrtorTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Michael Cava conducted a Pre-Licensing Inspection with the facility administrator, Lucia Nguyen, and house and program managers Samantha Maggio, Tracy Bangar and Marc Botezatu. An Application to operate a Short Term Social Rehab Facility was received by Community Care Licensing (CCL) on June 21, 2022. A fire clearance was approved on June 14, 2022 for a total of six (6) ambulatory only clients. The facility is a one story building, consisting of four (4) bedrooms and seven (7) bathrooms. The smoke alarms and carbon monoxide detector are combined and inter-connected. The facility has three fire extinguishers that were charged on August 30, 2022. The fire extinguishers were located at the kitchen, dining room and staff office.

A tour of the physical plant was initiated at approximately 10:50am and the following was observed:

KITCHEN: The facility has a kitchen area that is equipped with a refrigerator, microwave oven and sink. There were adequate supplies of nonperishable food and dining ware to accommodate a maximum capacity of six (6). Knives were kept locked and inaccessible in a kitchen drawer.

BEDROOMS: There are four (4) bedrooms designated for client use. Bedroom #1 and #2 are shared rooms. Bedroom #3 and #4 are private. The applicant furnished the resident bedrooms with beds, night stand, chairs, dresser, bedding and linen. The bedrooms have sufficient lighting and closet space.

BATHROOMS: The facility has four (4) bathrooms, of which three (3) are designated for client use and one (1) are for staff use. The bathrooms designated for client use were observed to have the proper fixtures, and non-skid floors and mats. The hot water delivered in the bathrooms measured at 117 degrees.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: PARADIGM MALIBU PCH
FACILITY NUMBER: 197610315
VISIT DATE: 12/13/2022
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COMMON AREAS: These included the living room, dining room, therapy and group rooms. They were equipped with furniture, a television, tables and chairs. There is a fireplace with a screen. It is non-operational, with the key stored and inaccessible to clients. No fireplace tools or fixtures present. The dining area has a large dining room table to accommodate six (6) to eight (8) people. There were no visible immediate hazards.

LAUNDRY ROOM: The laundry room is located at the hallway, in between client rooms. Detergents and cleaning supplies will be maintained here and it will be kept locked and inaccessible to clients. The washer/dryer are new.

MEDICATIONS: The medications will be maintained and stored in the staff office, which will remain locked and inaccessible to the clients.

OFFICE/STAFF WORKSTATION: Staff office is located to the right, at the front entrance. Client and personnel files will be maintained there. Staff office will be locked and inaccessible to the clients.

SURROUNDING GROUNDS: The driveway, walkways, entry and exit doors were clear of obstruction. The backyard of the facility has a patio and backyard furniture to accommodate the clients. The facility backyard has sufficient yard space. There is a swimming pool that is fenced all around with a gate that will be kept locked at all times. The fence surrounding the swimming pool is approximately 5 feet high all around its parameters. You will need a key to unlock the gate to gain entry to the swimming pool as it is kept locked at all times.

In addition to the Pre-Licensing inspection, a Component III power point presentation was also held.

Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised and a copy of this report provided.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
LIC809 (FAS) - (06/04)
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