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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216804051
Report Date: 04/19/2022
Date Signed: 04/19/2022 11:19:01 AM

Document Has Been Signed on 04/19/2022 11:19 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:PARADIGM TREATMENT CENTERSFACILITY NUMBER:
216804051
ADMINISTRATOR:GUYOT, MELISSAFACILITY TYPE:
772
ADDRESS:46 ARGUELLO CIRCLETELEPHONE:
(310) 457-7128
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY: 6CENSUS: 0DATE:
04/19/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Administrator, Melissa GuyotTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA), Farhaan Sarangi arrived at Paradigm Treatment Centers for the purpose of conducting a Pre-licensing inspection. LPA was greeted at the door by Administrator, Melissa Guyot and Facilities Manager, Amanda Odren. LPA was granted access into the facility. Facility has a capacity for 6 clients and has an approved Fire Clearance for that capacity. During today's inspection, there were 0 clients in care at the time of the Pre-Licensing inspection.

LPA toured the facility with the Administrator and Facility Manager. During the tour, the facility was inspected and found to be cleaned and at in good repair. Fire Extinguishers are dated for December 2021. Smoke detectors and carbon monoxide detector were found to be operational and working at the time of the inspection. The facility has a phone line designated for clients use. Hot water temperature measured between 116 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in all bathrooms while touring. There was an ample supply of personal hygiene products, bedding and linens, utensils and dishes were observed. First Aid kit was found to be appropriate during the inspection. There were emergency supplies available at the time of the inspection. Medications, Personnel records and client’s records are stored at the facility in locked cabinets in the staff office. There was an ample supply of perishable and non-perishable foods. Clients bedrooms have all required lighting & appropriate furnishings as per Title 22 Regulations. Toxins are to be stored in a locked and inaccessible to clients in care. There was a supply of cleaners, hygiene products and paper products available for clients. The bathrooms designated for clients at the facility were supplied with individual paper towels and hand soap. All bedrooms have lighting & appropriate furnishings.

LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Facility has sufficient Personal Protective Equipment (PPE). Facility has is in the process of obtaining N95 Fit testing. (Report continued on LIC 809C)
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2022
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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: PARADIGM TREATMENT CENTERS
FACILITY NUMBER: 216804051
VISIT DATE: 04/19/2022
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Both the Emergency Disaster Plan and the COVID-19 Mitigation Plan was discussed during the Pre-Licensing Inspection. LPA approved the COVID-19 Mitigation Plan for the facility. LPA requested the following documents during the Pre-Licensing inspection:

-LIC 308 Designated Facility Responsibility
-LIC 500 Personnel Summary
-Copy of Certificate of Liability Insurance
-Copy of Lease agreement

Component III was completed with the Administrator on April 19, 2022 during the Pre-Licensing inspection.

No deficiencies were observed during today's Pre-Licensing inspection. Exit interview was conducted and a copy of this report was emailed to the facility Administrator and Facility Manager.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022
LIC809 (FAS) - (06/04)
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