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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880942
Report Date: 09/04/2024
Date Signed: 09/09/2024 09:30:05 AM


Document Has Been Signed on 09/09/2024 09:30 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 ON PICOFACILITY NUMBER:
331880942
ADMINISTRATOR:SCOGGINS, STEPHAN MCCLAINFACILITY TYPE:
740
ADDRESS:303 WEST PICO ROADTELEPHONE:
(760) 699-8433
CITY:PALM SPRINGSSTATE: CAZIP CODE:
92262
CAPACITY:6CENSUS: 0DATE:
09/04/2024
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Licensee Stephan Scoggins TIME COMPLETED:
04:05 PM
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On 9/4/24 Licensing Program Analyst's (LPAs) Valerie Flores and Abdoulaye Zerbo conducted an announced one (1) year required visit. LPA's were granted entry by Licensee, Stephan Scoggins, who was informed of the purpose of visit. At the time of the visit there were no residents residing at the facility. Licensee was observed to have obtained proper fingerprint clearance and was associated to the facility. LPA's observed the following during today's visit:

LPA's conducted a tour of the facility with Licensee, Stephan. The physical plant is a single-story structure that consisted of one live-in staff bedroom, three (3) resident bedrooms and four (4) bathrooms. The facility has a formal dining room, kitchen, living room, and a gated pool. Indoor and outdoor passageways were free of obstruction. The facility has more than a two (2) day supply of perishable foods and seven (7) day supply of non-perishable foods. Water temperature measured at 107.8-degree Fahrenheit meeting within the required limits. Dishes and utensils were in sufficient supply and in good repair. Knives and other sharp objects are stored in a locked drawer in the kitchen. Disinfectant and other cleaning solutions were observed in a locked cabinet in the hallway. According to Licensee, there are no firearms or ammunition on the premises. Resident bedrooms had the required bedding, furniture, and lighting. The dual smoke and carbon monoxide detectors were tested and were observed to be operable. Facility maintained the centrally stored medication in a locked closet in the utility room.



Continuation on LIC809C...
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Valerie FloresTELEPHONE: (951) 248-0308
LICENSING EVALUATOR SIGNATURE:
DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: PARADISE ON PICO
FACILITY NUMBER: 331880942
VISIT DATE: 09/04/2024
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Licensee, Stephan Scoggins, has never admitted any residents into the facility and has never hired any staff. Therefore, there are no staff/resident files for LPA's to review. Licensee/administrator file reviewed included but not limited to fire preparedness training, CPR, and Basic Life Instructor training. In the facility file maintained but not limited to a facility sketch, emergency disaster plan, and valid administrator certification. Personal rights, see something say something and employee rights are posted throughout the facility. During today's visit, LPA's did not observe any immediate violations or concerns.

An exit interview was conducted, and a copy of this report was reviewed and provided to Licensee, Stephan Scoggins.

SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Valerie FloresTELEPHONE: (951) 248-0308
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
LIC809 (FAS) - (06/04)
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