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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600693
Report Date: 03/14/2022
Date Signed: 03/14/2022 07:22:05 PM

Document Has Been Signed on 03/14/2022 07:22 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, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME:PARADISE PALACE 11FACILITY NUMBER:
198600693
ADMINISTRATOR:LOFTON, JANICEFACILITY TYPE:
735
ADDRESS:5134 W 136TH STTELEPHONE:
(310) 355-5997
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY: 3CENSUS: 2DATE:
03/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Janice LoftonTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Jey Cardenas conducted an unannounced required annual visit with a primary focus on Infection Control measures using the new CARE Inspection Tools. Upon arrival at the facility, LPA Cardenas met with caregiver staff, Detrice Johnson and conducted a risk assessment; based on the assessment, the facility is clear of Covid-19 infection. LPA was properly screened for Covid-19 symptoms and temperature was checked. LPA verified that the facility has an approved mitigation plan report. Administrator, Janice Lofton assisted LPA with inspection; also present was Licensee Brenda Chandler. Facility is approved for three (3) developmentally disabled clients ages 18-59 years, facility prefers to serve Developmentally Disabled adults.

LPA and administrator both toured the inside and outside grounds of the facility. Facility is a one-story family home located in a residential area; house consisted of (3) client bedrooms, two (2) bathrooms, living room, dining room, family room, kitchen, backyard and enclosed patio area with table and chairs, backyard with two seat swing, and non-attached garage/ storage/ office.


During the tour, LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the facility entrance; visitors log with Covid-19 screening and temperature log, and records of daily Covid-19 screening and temperature checks of residents and staff. PPE supplies are readily available to staff, and an additional 60+ day supply of PPE was observed. Sufficient paper, cleaning, and disinfecting supplies were observed. LPA observed staff wear a face covering. LPA was informed that all staff and clients have been vaccinated and those eligible for boosters have been boosted. LPA observed required postings throughout the facility.

All rooms were inspected. Bedrooms are all private. Beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed.

Client bathroom were checked, sufficient liquid soap and paper towels were observed. Toilets and water

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Jey Cardenas
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2022
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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME: PARADISE PALACE 11
FACILITY NUMBER: 198600693
VISIT DATE: 03/14/2022
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LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxins were kept separate in a locked storage drawer/ cabinet. Centrally stored medications were observed stored in their originally received containers and kept safe and locked and inaccessible to clients in care. The First Aid kit was available. Dual Carbon Monoxide and Smoke Detectors (connected) were tested and operating. The facility has (1) Fire Extinguisher was checked and found to be fully charged and accessible, serviced on July 15, 2021. There are no security bars or weapons on the premises.

Outside grounds were toured, and no bodies of water were observed. Walkways around the home were clear of hazards. Common areas were clean and clear of hazards; doorways were free of obstructions.

No deficiencies were cited during this visit.

No deficiency were observed nor and cited from the California Code of Regulations, Title 22. Exit interview conducted. A copy of this report provided to administrator, Janice Lofton.

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Jey Cardenas
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022
LIC809 (FAS) - (06/04)
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