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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602382
Report Date: 05/13/2024
Date Signed: 05/13/2024 03:35:33 PM

Document Has Been Signed on 05/13/2024 03:35 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 DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:PARADISE HOME CAREFACILITY NUMBER:
374602382
ADMINISTRATOR/
DIRECTOR:		INOCENCIO, REMEDIOSFACILITY TYPE:
740
ADDRESS:4478 SAN JOAQUIN STREETTELEPHONE:
(760) 754-2774
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY: 6CENSUS: 6DATE:
05/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:50 PM
MET WITH:Administrator Remedios "Remy" InocencioTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced case management visit to conduct follow up regarding a self-reported incident report. LPA was greeted by, identified herself to, and explained the purpose of the visit to Administrator Remedios "Remy" Inocencio.

During today's visit, LPA observed residents in care. On 3/29/2024, the Department received a self reported incident report dated 3/28/2024 that described that on 3/18/2024, Resident 1 (R1) had eloped from the facility without staff supervision and returned the same day. During a case management visit on 4/30/2024, LPA conducted a health and safety check, observed residents in care, reviewed records, and interviewed residents and staff.

Interviews and review of facility's sign in sheet revealed that immediately prior to the elopement on 3/18/2024, R1 signed the facility's sign out sheet and indicated where R1 would be during their elopement. Interviews with the Administrator revealed that upon discovering that R1 had eloped from the facility, the Administrator contacted law enforcement to report that R1 had eloped from the facility. The Administrator also contacted R1's responsible party to notify them of R1's elopement. R1's responsible party was able to locate R1 and notified the Administrator of R1's location. Interviews with R1 and the Administrator revealed that R1 returned to the facility unharmed at around 1:00pm. Review of R1's medical assessment records revealed that R1 was not allowed the leave the facility unassisted. Review of the facility's absentee notification plan confirmed that the facility followed their absentee notification plan.

LPA provided Administrator with technical assistance regarding absentee notification plans on an LIC9102TA form.

No deficiencies were cited on today's date. An exit interview was conducted with Administrator Remedios "Remy" Inocencio, whose signature below confirms receipt of a copy of this report, the LIC9102TA, and the Licensee Appeal Rights (LIC9058 3/22).
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 05/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/13/2024
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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