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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306001582
Report Date: 01/05/2023
Date Signed: 01/10/2023 02:19:48 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/28/2022 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20221228135520
FACILITY NAME:PARAGON HOMEFACILITY NUMBER:
306001582
ADMINISTRATOR:RENATO MADRIGALFACILITY TYPE:
735
ADDRESS:2356 N BAILEY STREETTELEPHONE:
(714) 283-0228
CITY:ORANGESTATE: CAZIP CODE:
92867
CAPACITY:6CENSUS: 0DATE:
01/05/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Renato MadrigalTIME COMPLETED:
12:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Uncleared adult presently living at facility.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to initiate the investigation into the complaint received against this facility on December 28, 2022. LPA Haley was greated by staff and explained the reason for the visit. LPA Haley identified himself and discussed the purpose of the visit with staff. LPA Haley discussed the complaint allegation and interviewed Licensee/Administrator (AD) Renato Madrigal, and Staff 1 (S1).
Before the interview began LPA Haley toured the facility with S1. All clients were at the day program at the time of the visit. LPA Haley interviewed Licensee/Administrator (AD) Renato Madrigal, and Staff 1 (S1) regarding the complaint allegation.
Regarding the allegation: uncleared adult presently living at the facility.
Based on the information gathered during the investigation, document review and interviews, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated.
Continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 22-AS-20221228135520
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: PARAGON HOME
FACILITY NUMBER: 306001582
VISIT DATE: 01/05/2023
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
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27
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32
LPA Haley received a copy of the facility sketch, LIC500, DOJ Application Fingerprint Response for S2, and a face sheet for Client 1 (C1), Client 2 (C2), Client 3 (C3), and Client 4 (C4), and Client 5 (C5).

An exit interview was conducted and a copy of this report was provided.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2