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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006365
Report Date: 05/13/2024
Date Signed: 05/13/2024 03:57:40 PM

Document Has Been Signed on 05/13/2024 03:57 PM - 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 CAREFACILITY NUMBER:
306006365
ADMINISTRATOR/
DIRECTOR:		MARIN, MARICELLAFACILITY TYPE:
735
ADDRESS:2320 E. ROMNEYA DRIVETELEPHONE:
(714) 915-8794
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY: 4CENSUS: 4DATE:
05/13/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:07 PM
MET WITH:Maricella Marin, Rebekah Hayes, Leticia RamirezTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analysts (LPAs) Joseph Alejandre and Edward Kim conducted an announced visit to the facility to conduct the pre-licensing inspection. LPAs met with Applicants Maricella Marin and Rebekah Hayes and toured the facility.

An initial application to operate an Adult Residential Facility (ARF) was submitted to CCL on June 12, 2023. The facility is to have a capacity of 4 Ambulatory. Facility phone number 714-831-1333. LPAs observed the following. This is a change of ownership application with clients in care.

Structure:
The facility is a single story house with an detached 2 car garage with 4 bedrooms, 2 bathrooms, dining room, a kitchen, living room with a screened fireplace, and a laundry room.

Air/Heating:
Central air/heating system installed with a central panel to control entire house.

Client Bedrooms:
There are 4 client Bedrooms and each bedroom is private. The bedrooms are spacious and will easily accommodate the residents' belongings. All client rooms had the required furnishings and linens.

Medications, First-Aid Kit & Book:
The first aid kit and the first aid manual are stored in the hygiene closet by the front door. The first aid kit has all the required elements. Medications are stored in the laundry room and are kept locked.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 05/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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 CARE
FACILITY NUMBER: 306006365
VISIT DATE: 05/13/2024
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Bathrooms:
Both bathrooms have a working toilet, wash basin and walk in shower. All bathrooms are clean and operational.

Linens & Hygiene Supplies:
Adequate supply of linen stored in hall closet.

Emergency Phone Numbers, Exit Plan & Menu:
Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menus posted and available. Menus prepared one week prior and listed for food served for one week.

Food Service:
There is 2-day perishable and 7-day non-perishable food supply on hand.

Smoke Detectors/Carbon Monoxide Detectors:
Smoke detectors/carbon monoxide detectors tested operational. The fire extinguisher is mounted and fully charged in the laundry room.

Appliances:
There is an electric stove which includes an oven, microwave oven, a refrigerator, dishwasher, washer, and dryer. All appliances are clean and operational.

Toxins:
All cleaning supplies and chemicals are kept in the laundry room. The cleaning supplies and chemicals are locked in a cabinet.

Water Temperature:
Hot water was measured in both bathrooms. Hot water measured at 113.5 degrees Fahrenheit.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024
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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: PARADISE RESIDENTIAL CARE
FACILITY NUMBER: 306006365
VISIT DATE: 05/13/2024
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Resident & Staff Files:
The Resident and Staff Records will be kept locked in the garage.

Reading Material, Games, Equipment & Materials:
Arts and craft, tablet, and board games are stored in the dining room cabinet and in the garage. There is a large screen TV mounted in the living room. There is a basketball hoop in the backyard to play basketball. There is a soccer goal is in the backyard to play soccer. There is a treadmill and exercise bike for exercising.

Fire clearance:
Fire Clearance approved by Anaheim Fire Department Inspector Aaron Graef on July 14, 2023.

Component III:
Component three waived during visit. Applicant is Licensee/Administrator of other licensed facilities.

Facility is ready to be licensed. LPA will submit notification to CAB (Central Applications Bureau) in Sacramento for final review prior to license being issued. Applicant was informed today that the final approval will be processed by CAB in Sacramento.

Exit interview was conducted and a copy of this report was left with the applicant.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024
LIC809 (FAS) - (06/04)
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