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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336413057
Report Date: 04/18/2024
Date Signed: 04/18/2024 02:04:19 PM


Document Has Been Signed on 04/18/2024 02:04 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 IIFACILITY NUMBER:
336413057
ADMINISTRATOR:AGNES MARTINEZFACILITY TYPE:
740
ADDRESS:34036 ALBACETE AVETELEPHONE:
(951) 246-3363
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 6DATE:
04/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Caregiver, Chantale DargoTIME COMPLETED:
02:15 PM
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On 4/18/2024, Licensing Program Analyst (LPA) Janette Romero arrived unannounced to conduct an annual required inspection. LPA was greeted and granted entry by Caregiver, Chantale Dargo who was informed of the purpose of the visit. Administrator, Agnes Martinez was contacted and informed of LPA's visit. The facility has a fire clearance for six (6) non-ambulatory/bedridden residents. The facility also has an approved hospice waiver for five (5) residents and LPA was informed there are currently four (4) residents receiving hospice services at the facility.

During today's visit, there was six (6) residents and two (2) staff present. LPA conducted a tour of the facility's interior and exterior with Caregiver Dargo. During the tour, LPA observed the facility is made up of a one-story home with five (5) resident bedrooms, three (3) bathrooms, a kitchen, dining room, living room, laundry room and attached garage. There are no bodies of water on the premises. Indoor and outdoor passage ways were free of obstruction. Resident rooms had the required bedding, furniture and functional lighting. The facility has a fire alarm system and charged fire extinguishers serviced on 4/17/2024. Facility staff tested the smoke/carbon monoxide detectors and LPA found them to be operational. LPA toured the kitchen and observed the facility has a 2-day supply of perishable foods and 7-day supply of non-perishable food items, and food is stored in a safe and healthful manner. Emergency food and water are stored in the garage. Cleaning solutions, laundry detergent and disinfectants are secured in the locked laundry room. Additional cleaning solutions and disinfectants are secured in a cabinet stored in the garage. Medication is secured in a locked dining room cabinet. LPA reviewed all resident files and all residents have updated physician's reports. The facility does not safeguard residents' cash resources. During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted and a copy of this report was reviewed and provided to Caregiver Dargo.
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 529-2930
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2024
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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