306005861-9-22-2026-22-AS-RMAZ-DY6NL5-20260922103258

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005861
Report Date: 09/22/2026
Date Signed: 09/22/2026 10:33:07 AM

Document Has Been Signed on 09/22/2026 10:33 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	PARADISE RESIDENTIAL SENIOR CARE		FACILITY NUMBER:	306005861
ADMINISTRATOR/ DIRECTOR:	REYES, ROSA ANGELICA		FACILITY TYPE:	740
ADDRESS:	24762 ARGUS ST.		TELEPHONE:	(949) 412-1620
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY: 6		CENSUS: 6	DATE:	09/22/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	07:29 AM
MET WITH:	Johan Mathews and Rosa Angelica Reyes, Administrators		TIME VISIT/ INSPECTION COMPLETED:	11:00 AM

NARRATIVE

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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility for the purpose of completing an annual required inspection. LPA arrived at the facility, was greeted by facility staff, and was granted entry. LPA explained the nature and purpose of the visit. Johan Mathews and Rosa Angelica Reyes, Administrators, arrived shortly thereafter and met with LPA. There are six (6) residents currently residing at the facility, two (2) of whom are receiving hospice services.

The facility is a single story home with five resident bedrooms, one of which is shared, one staff room, five resident bathrooms, a living room, a dining room, a kitchen, a family room, a laundry room, and an attached two car garage.

LPA conducted a tour of the interior and exterior of the facility. Department required postings were observed throughout the facility. The facility was operating within its approved capacity limitations.

The facility maintained a minimum of one (1) week of nonperishable food and two (2) days of perishable food supplies. Emergency food, emergency water, and emergency supplies were observed stored in the garage. The facility was maintained at a comfortable temperature.

LPA inspected the centrally stored medications, which were maintained in a secured and locked storage closet located in the entry hallway of the facility. LPA reviewed the medications and observed that they were appropriately labeled and stored in a manner inaccessible to residents in care. LPA also observed the first aid kit and first aid manual stored with the medications.

CONTINUED ON LIC809-C

Kevin Saborit-Guasch
Ruth Martinez
	DATE: 09/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: PARADISE RESIDENTIAL SENIOR CARE	FACILITY NUMBER: 306005861
	VISIT DATE: 09/22/2026

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LPA inspected the facility bathrooms and measured the hot water temperature at 106.5 degrees Fahrenheit. All bathrooms were observed to have adequate supplies of soap, toilet paper, and towels. Bathrooms were equipped with required safety features, including nonskid mats and grab bars. Lighting throughout the facility was sufficient to ensure the safety and comfort of residents.

The facility was equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPA observed that toxic chemicals, cleaning solutions, and disinfectants were stored in secured in the garage. The garage entry is through the laundry unit, washer and dryer observed to be in use at the time of visit.

The facility maintained a clean and adequate supply of linens. LPA inspected the residents' bedrooms and observed sufficient lighting to ensure safety and comfort. All bedrooms inspected contained the required components, and adequate storage space was provided for residents' personal belongings. Smoke detectors and carbon monoxide detectors were tested and found to be operational.

LPA toured the exterior of the facility and observed that outdoor passageways were free of obstructions. Several shaded seating areas were available for residents' use and enjoyment throughout the backyard areas of the facility.

LPA observed a fire extinguisher located in the kitchen and laundry unit. The fire extinguisher was charged, properly mounted, and had a service date of July 26, 2026. The facility conducts fire drills every three (3) months. LPA reviewed the facility's fire drill logs and verified that the most recent fire drill was conducted on August 27, 2026.

LPA proceeded with a review of facility records. LPA reviewed three (3) resident records and observed that all required documentation was present and maintained in the residents' files. LPA also reviewed two (2) employee records. All employees present had current criminal record clearances and were properly associated with the facility. LPA observed that the employee records reviewed contain current First Aid certifications.

Based on the observations and records reviewed during today's visit, no deficiencies were noted in the areas inspected pursuant to Title 22, Division 6 of the California Code of Regulations.

This report was reviewed with the Administrators, and a copy of the report was provided to the facility.

NAME OF LICENSING PROGRAM MANAGER: Kevin Saborit-Guasch
NAME OF LICENSING PROGRAM ANALYST: Ruth Martinez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2026

LIC809 (FAS) - (06/04)

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