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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330910554
Report Date: 11/03/2021
Date Signed: 11/03/2021 02:55:09 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:PARADISE GUEST RANCHFACILITY NUMBER:
330910554
ADMINISTRATOR:VASQUEZ, CONNIEFACILITY TYPE:
740
ADDRESS:19150 KRIS ROADTELEPHONE:
(760) 329-8905
CITY:SKY VALLEYSTATE: CAZIP CODE:
92241
CAPACITY:6CENSUS: 2DATE:
11/03/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Licensee, Connie VasquezTIME COMPLETED:
11:30 PM
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An Informal Meeting was conducted today November 3, 2021 virtually via Microsoft Teams to discuss items listed below. Present at today’s meeting were: Licensee, Connie Vasquez, Licensing Program Manager, Joel Esquivel, and Licensing Program Analyst, David Cuevas.

During today’s conference, the following matter was discussed:
  • Type A, SUBSTANTIATED allegation of: Staff did not allow emergency medical personnel access to resident's room.
  • Staff live scan for staff and association
  • Carbon monoxide deficiency
  • Smoke detectors inoperable deficiency
  • Reporting Requirements
  • Ms. Vasques was offered to participate in Technical Support Program (TSP) during todays informal meeting that is offered through DSS.

Licensee, Ms Vasquez decline participation to TSP program at this time.During todays informal meeting Licensee agreed to be in compliance to the items listed above, moving forward.

An exit interview was conducted where this report was discussed and provided to the licensee. LPA emailed copy of the report for signature and requested the signed copy to be emailed back. Licensee agreed

SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: David CuevasTELEPHONE: (951) 295-3927
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
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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