374602382-11-29-2023-08-AS-SJAB-CY3VHK-20231130152716

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602382
Report Date: 11/29/2023
Date Signed: 11/29/2023 12:37:26 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/22/2022 and conducted by Evaluator Iby Strong

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20220322154451

FACILITY NAME:	PARADISE HOME CARE		FACILITY NUMBER:	374602382
ADMINISTRATOR:	INOCENCIO, REMEDIOS		FACILITY TYPE:	740
ADDRESS:	4478 SAN JOAQUIN STREET		TELEPHONE:	(760) 754-2774
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92057
CAPACITY:	6	CENSUS: 4	DATE:	11/29/2023
		UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Caregiver Iluminada Newton		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Administrator did not provide written admission agreement.
Administrator did not allow resident to have access to personal possessions.
Staff did not treat the residents with dignity.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to deliver findings in the above complaint allegations. LPA identified herself and discussed the purpose of the visit with Caregiver Iluminada Newton.

On March 22, 2022, Community Care Licensing (CCL) received a complaint alleging administrator did not provide written admissions agreement to Resident 1 (R1), administrator did not allow R1 to have access to personal possessions and staff did not treat multiple residents with dignity. During investigation, LPA Strong collected pertinent resident records as well as facility documentation, conducted interviews and made observations.

According to allegation, R1 was not allotted a copy of admissions agreement. Records revealed R1 moved into facility on February 21, 2022, and LPA Strong viewed a signed admissions agreement from February 27, 2022. Interview with R1 on April 1, 2022, revealed that R1 had not yet signed or received an admissions agreement.
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

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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Control Number 08-AS-20220322154451

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: PARADISE HOME CARE	FACILITY NUMBER: 374602382
	VISIT DATE: 11/29/2023

NARRATIVE

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Interview with administrator revealed R1 was issued a copy of the admissions agreement. Interview with an outside source revealed there were no issue with other admissions agreements and/or receiving copies of resident records when requested.

It was also alleged that R1 was not allowed to move in personal possessions into bedroom. Interview with staff revealed that R1 had items that were not able to be stored inside the facility without safety hazards. Interview with R1 revealed R1 then invested in a storage unit to safeguard personal property that did not fit into the facility. During April 1, 2022, facility inspection, LPA Strong observed R1’s room with a closet, drawers as well as multiple bedside tables with personal possessions. Interview with outside source did not reveal any issues with residents not being able to access their personal possessions on the facility property.

Lastly, it was alleged that Staff 1 (S1) yelled at R1 and other residents. Interviews with S1 revealed that S1 has not raised their voice towards any resident. Interview with staff established that there have been no witnessed incidents between S1 and residents. Interview with residents did not corroborate that S1 is treating residents rudely. Interview with an outside source revealed no issues with staff not treating residents without dignity.

Based on LPA's interviews, observations, and record reviews there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegation is unsubstantiated. An exit interview was conducted with Caregiver Iluminada Newton, to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

LIC9099 (FAS) - (06/04)

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