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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216803887
Report Date: 07/31/2023
Date Signed: 07/31/2023 09:43:13 AM


Document Has Been Signed on 07/31/2023 09:43 AM - 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:PARADISE ELDERLY RESIDENTIAL CARE OF MARINFACILITY NUMBER:
216803887
ADMINISTRATOR:GABAYAN, ALELIFACILITY TYPE:
740
ADDRESS:4210 PARADISE DRTELEPHONE:
(415) 650-7793
CITY:TIBURONSTATE: CAZIP CODE:
94920
CAPACITY:4CENSUS: DATE:
07/31/2023
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Aleli Gabayan (Licensee)TIME COMPLETED:
09:58 AM
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Licensing Program Analyst (LPA) Cuadra arrived at the home for the purpose of conducting a closure inspection pursuant to voluntary closure of this licensed Residential Care Facility for the Elderly. LPA/Licensee toured the facility and licensee told LPA that they are in the process of retirement.

LPA inspected all rooms and the exterior of the building today and found no evidence that would suggest that any clients are residing on the premises. All clothing and personal items belonging to clients have also been removed.

The Licensee initiated this facility closure with plans for retirement and did not submitted a closure plan. On 7/12/2023 LPA received a phone call from Licensee notifying CCL about their plan to close the facility. Per Licensee, they did not have any residents for a while so no eviction letter was given. Closure of this facility has been finalized. Facility was closed effective 7/31/23. Licensee turned over copy of License during today's inspection.

No deficiencies cited during today's visit.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:
DATE: 07/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2023
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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