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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005821
Report Date: 06/08/2022
Date Signed: 06/08/2022 11:36:00 AM


Document Has Been Signed on 06/08/2022 11:36 AM - It Cannot Be Edited

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 BLVDTELEPHONE:
(714) 591-5850
CITY:GARDEN GROVESTATE: CAZIP CODE:
92843
CAPACITY:6CENSUS: 6DATE:
06/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:24 AM
MET WITH:Tessie Damicog and Mylene BaldazoTIME COMPLETED:
10:55 AM
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted and granted entry into the facility by Manager Mylene Baldazo and explained the reason for the visit. Administrator Tessie Damicog was present as well. LPA was screened upon entry into the facility.
At 9:40 AM, LPA toured the facility with Administrator Damicog and Manager Mylene Baldazo. Facility has 6 residents in care during today's visit. LPA observed residents relaxing in the facility. All residents appeared happy and well taken care of. Facility appears clean and sanitary. All residents rooms had the required elements as well as restrooms stocked with soap/ sanitizer and paper towels. Restrooms have hand washing signage posted. Facility screens all visitors to the facility and LPA observed the screening/ sanitizing station in the entrance of the facility. Facility utilizes a visitor sign in sheet. Facility takes resident temperatures daily and documents results. Facility has covid precaution postings as well as all required department postings. Administrator Damicog has an administrator certificate expiring on 06/26/2022. Facility has completed the mitigation plan and LPA observed the emergency disaster plan posted in facility as well. LPA observed adequate emergency food and water as well as the first aid kit which contained all required items. Smoke detectors/ carbon monoxide detectors are hardwired and tested operational at time of visit. LPA toured the outside grounds and observed ample shaded outside visitation area. LPA observed a back house on-site where administrator resides. Facility conducts activities outside in the backyard including dancing, karaoke, and bingo. LPA observed the locked medication storage area. Facility has ample supply of PPE and cleaning supplies. Facility has a plan for covid testing residents and staff as needed as well as a plan for isolation. All staff and residents are vaccinated for Covid-19. LPA reviewed all resident files and all files have required documents including updated emergency information.
LPA consulted with Administrator regarding the importance of maintaining an ample supply of emergency water on-site at all times as well as ensuring exit gate is unlocked at all times..
No deficiencies noted during today's visit. An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2022
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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