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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004276
Report Date: 01/12/2021
Date Signed: 01/12/2021 01:52:56 PM

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 HOME & GARDENFACILITY NUMBER:
306004276
ADMINISTRATOR:RAFAEL & JOSEPHINE TEEHANKFACILITY TYPE:
740
ADDRESS:26761 CARRANZA DRIVETELEPHONE:
(949) 305-2881
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 5DATE:
01/12/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:42 PM
MET WITH:Adminitrator Josie TeehankeeTIME COMPLETED:
02:00 PM
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As precautionary measures during Coronavirus 2019 pandemic, Licensing Program Analyst (LPA) Albert Marin made a unannounced video teleconference. LPA met with Staff 1; and stated the purpose of the televisit.

Assisted by Staff 1, LPA Marin toured the interior of the facility. LPA observed 5 residents in care and two staff members on duty - Staff 1 and Staff 2. LPA did not observe any other individual inside the facility. Staff 1 stated that Applicant 1 did not work in the facility.

LPA Marin conducted an phone exit interview with AD Josie Teehankee. LPA will provide copy of this report via email; and as agreed AD J. Teehankee will acknowledge its receipt.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Albert MarinTELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2021
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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