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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336412274
Report Date: 04/16/2025
Date Signed: 04/16/2025 10:51:10 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/02/2021 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210302102529
FACILITY NAME:BIRD OF PARADISE ASSISTED LIVING IN TEMECULAFACILITY NUMBER:
336412274
ADMINISTRATOR:SUON, SARAKFACILITY TYPE:
740
ADDRESS:44754 PRIDE MOUNTAIN STTELEPHONE:
(951) 302-1335
CITY:TEMECULASTATE: CAZIP CODE:
92592
CAPACITY:0CENSUS: 0DATE:
04/16/2025
UNANNOUNCEDTIME BEGAN:
10:08 AM
MET WITH:TIME COMPLETED:
10:50 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not meet resident's hygiene needs.
Staff did not follow resident's care plan.
Staff did not practice universal precautions.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 4/16/2025, Licensing Program Analyst (LPA) Mary Rico mailed a certificated letter to deliver the findings on the three (3) allegations listed above.

For the allegations, (Allegation #1) Staff did not meet resident's hygiene needs, (Allegation#2) Staff did not follow reident's care plan. (Allegation#3) Staff did not pratice universal precautions.

During the investiagtion, LPA Rico did not find evidence to corroborate the (3)allegations.

Based on the evidence found during the investigation, the three (3) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. A copy of this report was mailed to facility’s designated mailing address.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Mary RicoTELEPHONE: (915) 255-6866
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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