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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004276
Report Date: 12/07/2021
Date Signed: 12/07/2021 05:01:20 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: 6DATE:
12/07/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:44 PM
MET WITH:Administrator (AD) Josie Teehankee TIME COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA) Albert Marin made an unannounced case management to this facility. LPA met with Administrator Josie Teehankee; and stated the purpose of this visit.

On December 6, 2021, AD J. Teehankee sent to Community Care Licensing Division (CCLD) Orange Office incident report involving Resident 1. The report described incidences of alleged violation against resident's personal rights.

For this visit, LPA Marin observed six residents in care, a family member, and three staff members on the floor. LPA toured the interior and exterior portions of the facility. After the tour, LPA conducted interviews.

Due to time constraints, this visit needs further investigation and will be completed at a later time.

No citation was issued during this visit.

LPA advised AD J. Teehankee to send all incident reports to CCLASCPOrangeCountyRO@dss.ca.gov

LPA Marin conducted an exit interview with Administrator J. Teehankee; and copy of this report was left in the facility.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert MarinTELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021
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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