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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002535
Report Date: 12/20/2023
Date Signed: 12/20/2023 09:42:04 AM


Document Has Been Signed on 12/20/2023 09:42 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:PARADISE RESIDENTIAL HOMEFACILITY NUMBER:
306002535
ADMINISTRATOR:NOEMI FIGUEROAFACILITY TYPE:
740
ADDRESS:546 N. WRIGHTWOOD DRIVETELEPHONE:
(714) 516-2750
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY:6CENSUS: 3DATE:
12/20/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Noemi Figueroa - Licensee/AdministratorTIME COMPLETED:
09:55 AM
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Licensing Program Analyst (LPA) Jerome Haley conducted a case management visit regarding observations and information discovered during the investigation into complaint control # 22-AS-202308090154540.

During the complaint investigation mentioned above, it was discovered Individual 1 (I1) was still living in the facility as of August 9, 2023.

During the complaint investigation above, On August 9, 2023, Licensee/Administrator Nomei Figueroa told Orange Police officer I1 lives in the home with her. Administrator Figueroa told a Department Investigator, I1 visits her on Sundays to have dinner with her and the family. Further, during a follow up visit to the facility November 7, 2023, LPA Haley observed I1 sitting in the kitchen when LPA arrived at the facility around 11:30AM. During the visit LPA Haley interviewed I1 before the individual left the facility.

I1 was previously excluded from the facility based on the individuals criminal record and is not allowed to be present in any licensed facility.

As a result of today’s Case Management visit, deficiencies will be cited.

An exit interview was conducted and a copy of this report, LIC809D, and appeal rights were provided.

SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome HaleyTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2023
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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Document Has Been Signed on 12/20/2023 09:42 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: PARADISE RESIDENTIAL HOME
FACILITY NUMBER: 306002535

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/21/2023
Section Cited
CCR
87355(f)(2)

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87355 Criminal record Clearance
(f) Violation of Section 87355(e) shall result in an immediate assessment of civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days by the department.
(2) The Department may assess civil penalties for continued violations as permitted by Health and Safety Code Section 1569.49.
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Licensee/Administrator Figueroa agrees to read and review regulation section 87355 and send in a signed statement of acknowledgement and understanding by the POC due date.
Licensee Figueroa will email the POC to LPA Haley by December 21, 2023 at 5:00PM
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This requirement is not being met as evidenced by the presence of Individual 1 (I1) in the facility August 9, 2023, November 7, 2023, witnessed by LPA Haley, and statements made by Licensee/Administrator Figueroa to Orange County Police August 9, 2023.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome HaleyTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2023
LIC809 (FAS) - (06/04)
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