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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530289
Report Date: 08/03/2026
Date Signed: 08/03/2026 12:22:10 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
07/30/2026 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20260730100812
FACILITY NAME:PARADISE SPRINGS FOR THE ELDERLY 1FACILITY NUMBER:
365530289
ADMINISTRATOR:MADAHAR, RENUFACILITY TYPE:
740
ADDRESS:9225 BANYAN STREETTELEPHONE:
(909) 463-8432
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91737
CAPACITY:6CENSUS: 6DATE:
08/03/2026
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Faryal Khan- LicenseeTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Unlawful Eviction
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver investigative findings. LPA met with Facility Administrator Faryal Khan and explained the purpose of the visit regarding the allegation stated above.

First allegation: Unlawful eviction. Regarding the allegation stated above, LPA conducted a file review pertaining to Resident #1 upon the review of records LPA observed that a 15-day eviction notice was issued to R#1 responsible party on 6/13/2026 for the reasoning that the facility could no longer meet the needs of R#1. LPA conducted an interview with Staff #1 regarding the alleged allegation and Staff #1 informed LPA that a reappraisal was not issued to R#1 to determine R#1 change of condition and to determine that the facility is not appropriate for R#1. Staff #1 informed LPA that R#1 left the facility on 6/14/2026. Staff #1 also indicated to LPA that the facility did not seek approval from Community Care Licensing Department prior to issuing the eviction notice.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 56-AS-20260730100812
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: PARADISE SPRINGS FOR THE ELDERLY 1
FACILITY NUMBER: 365530289
VISIT DATE: 08/03/2026
NARRATIVE
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Based on the evidence gathered during the investigation, the above allegation is Substantiated. A finding that the complaint is Substantiated means that the findings are valid because the preponderance of the evidence standard has been met. Title 22 Regulations, from division 6, chapter, article 6, is, cited on the attached LIC 9099 D.

An exit interview was conducted where this report, appeal rights, and LIC9099-D was discussed, and a copy of the report was provided to Facility Administrator Faryal Khan the conclusion of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20260730100812
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: PARADISE SPRINGS FOR THE ELDERLY 1
FACILITY NUMBER: 365530289
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/14/2026
Section Cited
CCR
87224(c)(d)(1)
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87224 Eviction Procedures…. (c) The licensee shall, in a) Then to either serving the required thirty (30) days notice , sixty (60) days notice or seeking approval from the Department and service three (3) days notice on the resident, notify or mail a copy of the notice to quit to the resident's responsible person….(d) The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons…. (1) The notice to quit shall include the following information:

This requirement is not met as evidence by:
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The Licensee has agreed to read: Eviction Procedures, regulation and provide training for staff regarding the correct procedures when issuing eviction notices. The Licensee will provide LPA with proof of training by emailing LPA training sign sheets by POC date 8/14/2026. In addition, the Licensee will provide R#1 family a refund according to the dates/percentages of when R#1 was admitted and when R#1 was discharged. Licensee will provide LPA with proof of refund that is issued to R#1. LPA observed that a refund in the amount of $820.81 was issued to R#1 on 7/3/2026. Any additional amount owed R#1 will be issued upon review and proof will be provided to LPA on POC date provided.
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Based on interviews and record review, the Licensee did not adhere to eviction regulation by issuing an unlawful eviction notice to R#1 and not properly following eviction procedures based on Title 22 regulation, which poses an immediate health, safety, or personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3