<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216804131
Report Date: 07/20/2023
Date Signed: 07/20/2023 03:50:49 PM

Document Has Been Signed on 07/20/2023 03:50 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: 4DATE:
07/20/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Program Director, Jordan and Administrator Melissa GuyotTIME COMPLETED:
04:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
At approximately 11:50AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Post-Licensing visit and met with Administrator/Clinical Director, Melissa Guyot and Program Director, Jordyn Bonanni. Facility has an approved fire clearance for 6 Ambulatory Clients. Upon arrival, LPA was informed that the Facility currently has four Clients in care and 9 staff on site.

LPA conducted a walk through of the facility and observed the following: 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.

LPA reviewed a sample size of 5 staff files and 4 Client Files. Staff files were all found to be well organized, thorough and contained the required documentation. LPA observed that 3 of 4 Client Files did not have Medical Assessments or TB test results on file (See Technical Advisories 81069(a) and 81069(f)(1)).Per conversation with Administrator, Facility has been documenting all communication attempts to get signed and dated Physician Reports for their Clients as well as obtaining Client Tuberculosis (TB) Test Results.

LPA discussed the importance of having current medical assessments and TB results on file.
LPA reviewed 4 Client Medications. Medication was observed to be centrally stored and secure.

Facility's hot water temperatures were observed to be over 120 degrees Fahrenheit during visit. Facility showed documentation of water temperature logs for the past 3 months which indicated that hot water temperature for all facility sinks were within Title 22 Regulations of 105 to 120 degrees Fahrenheit, ranging between 116-119 degrees (See Technical Advisory 81088(e)(1)).
Continued on LIC809C
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
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: 07/20/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continued from LIC809

Facility has a sufficient amount of perishable and nonperishable foods per regulation. Facility's first fire drill is scheduled to be conducted 07/26/2023. Facility's smoke detectors and carbon monoxide detectors were last inspected on 07/13/2023.

No Deficiencies Cited during Visit.

Exit interview conducted. Copy of report and Technical Advisories 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: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5