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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004280
Report Date: 09/23/2020
Date Signed: 09/23/2020 11:57:05 AM

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 SENIOR CAREFACILITY NUMBER:
306004280
ADMINISTRATOR:ROSA ANGELICA REYESFACILITY TYPE:
740
ADDRESS:24246 CASTILLA LANETELEPHONE:
(949) 716-6756
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 0DATE:
09/23/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Administrator Rosa Reyes TIME COMPLETED:
12:00 PM
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As precaution during the Coronavirus 2019 pandemic, Licensing Program Analyst (LPA) Albert Marin conducted a teleconference call to this facility. The video teleconference was participated by Administrator (AD) Rosa Reyes. LPA stated the purpose of this visit.

The Licensee had applied for new facility location. The Department granted and licensed a new facility number - 306005861 for Paradise Residential Senior Care. LPA confirmed the location by comparison with street images from online map services. LPA did a video teleconference tour of the facility assisted by the AD. LPA observed there was on ongoing construction on site. There were no residents in care. All 5 residents were transferred to the new location. AD agreed to send the copy of the license back to CCLD.

LPA will now process the closure of this facility.

An exit interview was conducted with AD. As agreed, LPA will provide a copy of this report to via email; and AD will acknowledge its receipt.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Albert MarinTELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2020
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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