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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361800177
Report Date: 03/18/2021
Date Signed: 03/18/2021 11:02:17 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:PARADISE FOR THE ELDERLY #2FACILITY NUMBER:
361800177
ADMINISTRATOR:MADAHAR, RENUFACILITY TYPE:
740
ADDRESS:8568 BAKER AVETELEPHONE:
(909) 463-8432
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY:6CENSUS: 6DATE:
03/18/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:24 AM
MET WITH:Renu Madahar, AdministratorTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA), Stephanie Torres, made a visit to the facility to conduct an unannounced health and safety inspection to address concerns relating to complaint # 18-AS-20210316173114. The LPA identified herself and discussed the purpose of the visit with Administrator, Renu Madahar. The LPA conducted resident interviews; no reports of concerns relating to neglect or lack of care and supervision were received. No immediate health and safety concerns were observed at time of visit.
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Stephanie TorresTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2021
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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