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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216804051
Report Date: 09/26/2022
Date Signed: 09/26/2022 12:29:11 PM

Document Has Been Signed on 09/26/2022 12:29 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:PARADIGM SAN FRANCISCO YOUNG ADULTFACILITY NUMBER:
216804051
ADMINISTRATOR:GUYOT, MELISSAFACILITY TYPE:
772
ADDRESS:46 ARGUELLO CIRCLETELEPHONE:
(310) 457-6300
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY: 6CENSUS: DATE:
09/26/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Program Director, TIME COMPLETED:
12:40 PM
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At approximately 9:45AM, Licensing Program Analyst (LPA) Felias arrived unannounced at Paradigm Treatment Centers to conduct a Post-Licensing Inspection visit and met with Staff Member, Priscilla Alcorn. Program Director, Ramon Sranna, arrived later during the visit. Administrator, Melissa Guyot, was available by telephone. Facility has a capacity for 6 clients and has an approved Fire Clearance for that capacity. At the time of the Post-Licensing Inspection, there were 2 clients in care. The Inspection is focused on the Infection Control procedures and practices of this facility.

LPA conducted a walk-through of the facility and observed the following: Hand-washing signs were observed in the bathrooms and at sinks. Observed staff were wearing masks. The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. For visitors, Facility utilizes a sign-in sheet and requests for a negative COVID test to be reviewed within 24 hours of their visit date.

LPA and Administrator discussed the following: adding a symptom questionnaire to their sign-in log, screening Staff and Clients daily for COVID symptoms, and adding more COVID-signs throughout the facility such as Cough Etiquette. LPA and Administrator discussed N95-Fit Testing and available resources. Facility is in the process of obtaining Testing for all staff.

All staff have received training on Infection Control. Facility has a cleaning and disinfecting schedule that occurs once per day. Facility has at least a 30-day supply of Personal Protective Equipment (PPE) and medication for Clients.

While conducting tour, LPA noticed blue tape over one of the bathroom toilets. Per conversation with Administrator, on Thursday, 9/22/2022, it was observed that one of the bathrooms toilets and the washing machine was not working properly due to the line needing to be unblocked.

Continued on LIC 809C
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2022
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 SAN FRANCISCO YOUNG ADULT
FACILITY NUMBER: 216804051
VISIT DATE: 09/26/2022
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Continued from LIC-809

The blockage in the pipes caused the washing machine and the toilet to not drain properly. Plumbing Company was promptly contacted and fixed it the same day. On Sunday, 9/25/2022, Facility became aware that the other two toilets had a similar problem. Per conversation with Administrator, Plumbing Company was contacted again and are expected fix the pipes by Tuesday, 9/27/2022. Facility to send in a picture of fixed toilets once completed.

Fire Extinguishers was last serviced December 2021. Per Administrator, Facility has a central fire alarm system that is directly connected to the Fire Department. The last Emergency/Fire Drill was conducted September 2022. Smoke Detectors and Carbon Monoxide Detectors were tested and operational.

No Deficiencies cited during visit.

Exit interview conducted. Copy of report and LIC-9102 (Technical Assistance Advisory) discussed and provided to Administrator. Signature on form confirms receipt of documents.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
LIC809 (FAS) - (06/04)
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