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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005821
Report Date: 06/09/2020
Date Signed: 06/09/2020 03:31:36 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 GARDEN GUEST HOMEFACILITY NUMBER:
306005821
ADMINISTRATOR:AZNAR, MARY GRACEFACILITY TYPE:
740
ADDRESS:13392 GARDEN GROVE BLVD.TELEPHONE:
(949) 381-9225
CITY:GARDEN GROVESTATE: CAZIP CODE:
92843
CAPACITY:6CENSUS: 5DATE:
06/09/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:02 PM
MET WITH:Mary AznarTIME COMPLETED:
03:26 PM
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Licensing Program Analyst (LPA) James August conducted an announced Pre-Licensing visit with Component III Orientation via a virtual video telephone call to Paradise Garden Guest Home due to COVID-19 and precautionary measures. LPA August conducted the visit with Administrator (AD) Mary Aznar. An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to the Central Applications Bureau (CAB) on 05/05/2020 for a capacity of 6 non-ambulatory residents.

Facility is a one story house with 3 resident bedrooms, 1 staff bedroom, 2 bathrooms, living room, dining area and kitchen. The backyard has a large grass area as well as a large shaded concrete area with seating for residents and their family. There was no debris in the backyard. LPA inspected several large locked storage sheds in the backyard and all sheds are being used to store general household supplies and tools. The backyard has a single self latching gate that leads to the front yard driveway. The driveway and front yard have a perimeter fence that is kept unlocked.



Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Bathrooms had one locked cabinet for any toxins. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions. Auditory alarms tested operational. Kitchen was inspected and appliances are in working order. Sharps, medications and toxins are kept in locked kitchen cabinets.

Smoke and carbon monoxide detectors are battery operated and tested operational during today's visit. Fire extinguishers were fully charged. The facility has multiple first aid kits. There are no security bars or weapons on the premises. Component III conducted at the Pre-Licensing visit, information provided about how to operate the facility within substantial compliance. CONTINUED ON LIC 809C DATED 06/09/2020...

SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: James AugustTELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2020
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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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 GARDEN GUEST HOME
FACILITY NUMBER: 306005821
VISIT DATE: 06/09/2020
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The items reviewed during today’s visit are in compliance. Facility appears ready for licensure. The license will be granted upon completion of a final review and approval from the Central Applications Bureau.

An exit phone interview was conducted with Administrator Aznar and a copy of this report was signed by LPA James August. This report will be sent via email to Administrator Aznar who agrees to sign the report and return same via email within 24 hours.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: James AugustTELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2020
LIC809 (FAS) - (06/04)
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