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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330910554
Report Date: 04/24/2024
Date Signed: 04/24/2024 11:35:36 AM


Document Has Been Signed on 04/24/2024 11:35 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
RIVERSIDE ASC, 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: 0DATE:
04/24/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Connie Vasquez - LicenseeTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced to conduct the facility's annual inspection. Upon arrival, LPA Colvin met with Licensee Connie Vasquez, who informed LPA Colvin that she has surrendered her license and is no longer operating.

LPA Colvin conducted a tour of the location and confirmed only the Licensee and her son and his girlfriend were present. LPA Colvin noted that when someone from the Department was last at the facility on 6/10/22, there was a census of 2 residents. Licensee Connie Vasquez provided LPA Colvin with information on what happened to all 3 of her past residents (2 moved and one passed away). Licensee Connie Vasquez additionally stated that she called Licensing in early March and spoke with the Duty Officer to inform them of her closing the facility.

LPA Colvin confirmed no residents present and that the facility is no longer operating during today's visit. Licensee has surrendered her license to LPA Colvin during the inspection. LPA Colvin will close the facility back at the office with a closure date of today.

An exit interview was conducted with Licensee Connie Vasquez wherein a copy of this report was provided.
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:
DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/24/2024
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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