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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001582
Report Date: 09/20/2023
Date Signed: 09/20/2023 09:21:11 AM

Document Has Been Signed on 09/20/2023 09:21 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
ORANGE COUNTY ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
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: 4DATE:
09/20/2023
TYPE OF VISIT:POCANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Emmanuel Madrigal - AdministratorTIME COMPLETED:
09:45 AM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. made an announced visit to Paragon Home for the purpose of conducting a Plan of Corrections visit. LPA arrived at 8:33 am and was greeted and granted entry by Caregivier Aldrin Demerin. Administrator (AD) Emmanuel Madrigal joined the visit at 8:50am.

LPA stated they would be verifying the following corrections:

1. Facility staff will move unused appliances.
2. The Licensee will remove the panel that sealed entry and exit to the staff bedroom.

LPA observed the appliances in the garage and backyard to be removed. LPA took photographs of where the unused appliances were previously stored. The billiards table has not been moved, however, the AD called the LPA on 9/19/23 to state that he would be refurbishing the billiards table for the residents to use. During today's visit, LPA observed the billiards table to be out of the way and not presenting a health and safety risk. LPA also observed the process of refurbishing the billiards table has begun.

LPA also observed the doorway to the staff bedroom to be accessible.

LPA also noted that the facility applied the following suggestions from the annual visit:

1. Rotate the doorknob leading from the kitchen to the garage so that residents don't have access to the garage.
2. Clear the garage of clutter. The clutter did not present a health and safety risk to the residents, but the facility still took it upon themselves to organize the garage more.

Based on LPAs observations as evidenced by photos taken by the LPA, the facility has met the Plan of Corrections by the assigned due date and the LPA has cleared the two deficiencies.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2023
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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