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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530359
Report Date: 03/24/2026
Date Signed: 03/24/2026 06:09:03 PM

Document Has Been Signed on 03/24/2026 06:09 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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:PARADISE GARDENS MANORFACILITY NUMBER:
365530359
ADMINISTRATOR/
DIRECTOR:		BARD, SCHAMONEFACILITY TYPE:
740
ADDRESS:1350 WABASH AVENUETELEPHONE:
(909) 794-1040
CITY:MENTONESTATE: CAZIP CODE:
92359
CAPACITY: 63CENSUS: 51DATE:
03/24/2026
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:20 PM
MET WITH:Administrator Melissa BuckridgeTIME VISIT/
INSPECTION COMPLETED:
06:10 PM
NARRATIVE
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On March 24, 2026 (3/24/2026), Licensing Program Analysts (LPA), Andrew Martinez conducted an announced prelicensing visit to the facility. LPA met with Administrator, Melissa Buckridge and restated the purpose of the visit. An application for Change of Ownership at Resident Care Facility for the Elderly (RCFE) currently licensed as Rose Gardens Residential Care (366426422) was submitted to the Central Applications Bureau (CAB) on LIC 200 dated 12/23/2025. A fire clearance was granted by San Bernardino County Fire Department on 02/06/2026 for a total capacity of sixty-three (63) bedridden residents.

LPA conducted a tour of the facility accompanied by Administrator Buckridge where the following was observed:
Physical Plant (Indoor/Outdoor): The facility consists of four (4) detached resident living quarters equipped with living rooms, individual and shared bathrooms. Other areas consist of an activities room, dining hall, kitchen, laundry room, staff break room, nurses station, designated medications area, maintenance room, supply room, and extra storage rooms and sheds. Indoor and outdoor passageways are free of obstructions. No bodies of water were observed. Outdoor activity area is enclosed by a gate with adequate outdoor shaded area for client activities. There is adequate amount of furniture in good repair, seating, and space in the common areas for client activities. The facility is equipped with multiple fully charged fire extinguishers, smoke alarms and carbon monoxide detectors in working condition, and laundry equipment. There are designated locked rooms where sharps and cleaning supplies are stored. The facility is maintained at a comfortable temperature at 76 degrees Fahrenheit throughout the living quarters of the residents. One fireplace was observed on property in the Activities Room covered and not in use. The facility's telephone service was confirmed to be connected.
*** Continuation on LIC 809-C ***
NAME OF LICENSING PROGRAM MANAGER: Karen Clemons
NAME OF LICENSING PROGRAM ANALYST: Andrew Martinez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: PARADISE GARDENS MANOR
FACILITY NUMBER: 365530359
VISIT DATE: 03/24/2026
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Bedrooms: Resident bedrooms are equipped with mattresses, chairs, and overhead lighting. Bedrooms were observed with not having nightstands, lamps, waste receptacles with lids, laundry hampers with lids, and a chest of drawers for each resident. A Technical Assistance is being provided.

Bathrooms: Resident bathrooms are clean and equipped with operating toilets, washbasins, and showers. Hot water temperature measured at 122.7 degrees Fahrenheit (Rm 3), 102.9 degrees (dining hall), and 114.2 degrees (Rm A). A Technical Assistance is being provided for hot water correction.

Supplies: The facility maintains clean linens, sufficient toiletry supplies, activity supplies, emergency flashlights and first-aid kit with manual.

Food Service: The kitchen and food preparation areas are clean with an adequate number of cups, dishes, and utensils for resident use. Food storage is equipped with enough food for a seven (7) day supply of non-perishable foods. Refrigerator and freezer are clean and operate in good condition. There is enough storage for at least two (2) days of perishable foods. Food menus posted for resident viewing.

Medications: A designated central medication storage room was observed locked and secure.

Administration: Facility sketch, residents' personal rights, administrators certificate, emergency disaster plan, and telephone numbers are posted in a common area. CCLD complaint poster and visiting policy is missing and required to be posted. Bedrooms: Resident bedrooms are equipped with mattresses, chairs, and overhead lighting. Bedrooms were observed with not having nightstands, lamps, waste receptacles with lids, laundry hampers with lids, and a chest of drawers for each resident. A Technical Assistance is being provided.

Bathrooms: Resident bathrooms are clean and equipped with operating toilets, washbasins, and showers. Hot water temperature measured at 122.7 degrees Fahrenheit (Rm 3), 102.9 degrees (dining hall), and 114.2 degrees (Rm A). A Technical Assistance is being provided for hot water correction.

Supplies: The facility maintains clean linens, sufficient toiletry supplies, activity supplies, emergency flashlights and first-aid kit with manual.

Food Service: The kitchen and food preparation areas are clean with an adequate number of cups, dishes, and utensils for resident use. Food storage is equipped with enough food for a seven (7) day supply of non-perishable foods. Refrigerator and freezer are clean and operate in good condition. There is enough storage for at least two (2) days of perishable foods. Food menus posted for resident viewing.

Medications: A designated central medication storage room was observed locked and secure.

Administration: Facility sketch, residents' personal rights, CCLD complaint poster, administrators certificate, emergency disaster plan, and telephone numbers are posted in a common area. CCLD complaint poster and visiting policy is missing and required to be posted. A Technical Assistance is being provided.

Overall, the facility is clean and in good repair. The prelicensing inspection and the Component III orientation are complete. However, additional items are still needed to be completed prior to being licensing which include: correcting resident bedroom water heater temperatures to comply with regulation, posting adequate CCLD complaint and visitors policy posters in common areas, and procuring nightstands, lamps, waste receptacles with lids, laundry hamper with lids, and a chest of drawers for each resident in care.

An exit interview was conducted where this report was discussed, a copy of this Facility Evaluation Report LIC 809, Facility Evaluation Report continuation LIC 809-C, and LIC 9102 Technical Assistances were provided to the facility Administrator Buckridge at the conclusion of the visit.

NAME OF LICENSING PROGRAM MANAGER: Karen Clemons
NAME OF LICENSING PROGRAM ANALYST: Andrew Martinez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026
LIC809 (FAS) - (06/04)
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