336412122-5-15-2024-18-AS-JARA-D5AUD6-20240515152902

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336412122
Report Date: 05/15/2024
Date Signed: 05/15/2024 03:29:10 PM

Document Has Been Signed on 05/15/2024 03:29 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	PARADISE HOME		FACILITY NUMBER:	336412122
ADMINISTRATOR:	AGNES MARTINEZ		FACILITY TYPE:	740
ADDRESS:	34156 ALBACETE AVENUE		TELEPHONE:	(951) 672-9993
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92563
CAPACITY:	6	CENSUS: 5	DATE:	05/15/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Administrator, Agnes Martinez		TIME COMPLETED:	03:40 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced to the facility in order to conduct the required annual. LPA met with Administrator, Agnes Martinez who was informed of the purpose of the visit. There were (5) residents and (3) staff present during the time of the visit.

The facility is a one story home with (5) resident rooms and (3) bathrooms. There is an attached garage and outdoor space. No pools or firearms are beingkept at the facility. The facility is a residential care facility for the elderly. The following was observed:

The LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. Laundry equipment was observed to be in good condition. Hot water temperature was recorded at 115F.

LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods.

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira Arreola	TELEPHONE: 951-233-6759
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024

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 4

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 HOME	FACILITY NUMBER: 336412122
	VISIT DATE: 05/15/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Adequate staff are present for the supervision of residents during the visit. LPA reviewed (5) staff files and training as well as (5) client files. LPA issued technical note with (1) staff that had CPR certification expired within a few days. The licensee agreed to have staff recertify 5/16/2024 and send LPA proof of this. All client medication was locked in kitchen pantry. LPA reviewed MARS and bubble packs for clients and found medication was accounted for.

LPA reviewed documentation showing the facility's last fire drill 1/15/2024, the facility is late (1) month in conducting their fire drill. Technical note was issued and licensee agreed to conduct fire drill by the end of the month and send proof to LPA. LPA observed all facility exits were clear from obstructions. The carbon monoxide detectors were tested during the time of the visit and were operational. LPA observed emergency supplies and first aid kit.

No deficiencies were cited at the time of the visit. An exit interview was conducted with Agnes Martinez where this report was reviewed and provided to them.

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira Arreola	TELEPHONE: 951-233-6759
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024

LIC809 (FAS) - (06/04)

Page: 2 of 4