306004648-4-17-2023-22-AS-SSAS-CRBNAZ-20230428101822

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004648
Report Date: 04/17/2023
Date Signed: 04/17/2023 04:23:57 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/10/2023 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230410115817

FACILITY NAME:	PARADISE FOR THE ELDERLY #1		FACILITY NUMBER:	306004648
ADMINISTRATOR:	RENU MADAHAR		FACILITY TYPE:	740
ADDRESS:	525 N. CAROUSEL PL.		TELEPHONE:	(657) 208-3199
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92806
CAPACITY:	6	CENSUS: 3	DATE:	04/17/2023
		UNANNOUNCED	TIME BEGAN:	02:01 PM
MET WITH:	Renu Madahar, Administrator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Facility is dirty

Facility is malodorous

Staff do not shower residents

Staff do not provide meals to residents in a timely manner

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting an initial investigation into the allegations listed above. LPA was greeted and granted entry by caregiving staff after explaining the purpose of the visit. Administrator Renu Madahar was notified of the visit via telephone and arrived later to assist.

LPA accompanied by caregiver conducted a tour of the physical plant. There are currently three residents in care, one of which was observed in the facility's common area and the two others in their respective bedrooms. Facility physical plant is observed to be clean in all areas inspected.

LPA requested, obtained and reviewed resident facility and hospice records for all three individuals in care.

CONTINUED ON FORM LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20230410115817

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: PARADISE FOR THE ELDERLY #1	FACILITY NUMBER: 306004648
	VISIT DATE: 04/17/2023

NARRATIVE

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CONTINUED FROM FORM LIC9099

Regarding the allegation that Facility is dirty, the following has been concluded: Based on observation conducted during the tour of the physical plant, the facility's common areas, kitchen, living room, hallways and six private bedrooms are observed to be clean and free of obstructions. Therefore the allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

Regarding the allegation that Facility is malodorous, the following has been concluded: based on observation conducted during the tour of the physical plant, the facility's common areas, kitchen, living room, hallways and six private bedrooms are observed to be free of odors. Therefore the allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

Regarding the allegation that Staff do not shower residents, the following has been concluded: Based on staff, witness and resident interviews, it was confirmed that all three residents receive in-depth toileting care from either their respective hospice or home health providers, in addition with bedside toileting provided by caregiving staff based on wishes and needs observed. As a result, the allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

Regarding the allegation that Staff do not provide meals to residents in a timely manner, the following has been concluded: Facility staff was observed providing meals and/or snacks to two of the three residents during the facility visit whenever requested. The third resident is noted to no longer be able to swallow liquids or solids due to a major aspiration risk noted by hospice staff. The resident Physician orders for Life-Sustaining Treatment (POLST) states that all forms of artificial nutrition have been declined, the resident only receiving IV fluids as a comfort-focused treatment. As a result, the allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted and a copy of this report was provided to facility representative.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023

LIC9099 (FAS) - (06/04)

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