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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216804131
Report Date: 04/28/2023
Date Signed: 04/28/2023 02:05:51 PM

Document Has Been Signed on 04/28/2023 02:05 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 MARINAFACILITY NUMBER:
216804131
ADMINISTRATOR:GUYOT, MELISSAFACILITY TYPE:
772
ADDRESS:135 MARINA BLVDTELEPHONE:
(310) 457-6300
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY: 6CENSUS: 0DATE:
04/28/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Administrator, Melissa GuyotTIME COMPLETED:
02:15 PM
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At approximately 9:40AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Pre-Licensing visit and met with Administrator/Clinical Director, Melissa Guyot. Facility has an approved fire clearance for 6 Ambulatory clients. The facility currently has zero clients in care.

LPA conducted a walk through of the facility and observed the following: the Facility is a one story home with 2 single bedrooms, 2 shared bedrooms, 4 bathrooms, an office space, and common areas such as a kitchen, living room, and dining room. Facility has a swimming pool on site. LPA observed that the swimming pool has a perimeter fence and was locked at the time of visit. Per conversation with Administrator, the swimming pool is to be locked at all times unless in use. If clients want to use the swimming pool, there will be two staff members supervising. Administrator informed LPA that all staff have their Water Safety Certificates. LPA observed two fireplaces in the home. Per conversation with Administrator, the fireplaces will not be used and are only for decor purposes.

LPA also observed that the facility was clean and at a comfortable temperature with all exits free from obstruction. Bathrooms were equipped with necessary grab bars, and non-slip mats were present. Bathrooms were supplied with paper towels, liquid hand soap, and hand-washing signs. Toxins were secure and inaccessible to clients. There was a sufficient supply of hygiene products, paper products, and linens available for client use. Mattress pads were in place or available for client use. Hot water temperatures for all sinks in facility were within Title 22 regulations of 105 to 120 degrees Fahrenheit.

Facility has a sufficient amount of perishable and nonperishable foods per regulation. Facility has an adequate supply of kitchen tools. Per conversation with Administrator, sharps such as knives will be stored and locked in the facility's office space located in the garage. Sharps will only be given to clients during cooking time and will be supervised at all times.
Continued on LIC809C
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2023
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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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 MARINA
FACILITY NUMBER: 216804131
VISIT DATE: 04/28/2023
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Continued from LIC809

LPA observed medication cabinets in the facility's office space. Per conversation with Administrator, client medications will be located here and clients will wait in a designated area when receiving their medication.

There is one laundry area in the facility. Toxins and Detergents were observed to be located in an outside storage area, and was locked and inaccessible. Per conversation with Administrator, if clients want to do their laundry, they will ask a staff member for the detergent. The staff member will obtain the detergent from the outside storage area, and give it to the client once they are back inside the facility.

Per conversation with Administrator, the facility's main exit doors are not equipped with sensors/delayed egress. Clients will always be in the line of sight of Facility staff to ensure their safety.

Facility has an Emergency Disaster Plan in place. Fire extinguishers were last serviced August 2022. Combination Smoke and Carbon Monoxide Detectors were tested and operational. The last Emergency/Fire Drill was conducted April 2023.

LPA reviewed the Component III Orientation with Administrator.

Pre-Licensing completed. Component III Orientation conducted and completed. Facility will be ready to be Licensed as a Social Rehabilitation Facility.

No Advisories provided during visit.

LPA will submit Pre-Licensing Application Report to the Application Unit Analyst in Sacramento. Application Unit Analyst will notify Applicant of Status.

Exit interview conducted. Copy of report discussed and provided. Signature on form confirms receipt of documents.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023
LIC809 (FAS) - (06/04)
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