374602382-1-8-2025-08-AS-RABA-DCQV38-20250108150419

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374602382
Report Date: 01/08/2025
Date Signed: 01/08/2025 03:04:29 PM

Document Has Been Signed on 01/08/2025 03:04 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 CARE		FACILITY NUMBER:	374602382
ADMINISTRATOR/ DIRECTOR:	INOCENCIO, REMEDIOS		FACILITY TYPE:	740
ADDRESS:	4478 SAN JOAQUIN STREET		TELEPHONE:	(760) 754-2774
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92057
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 5	DATE:	01/08/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:45 AM
MET WITH:	Administrator Remedios "Remy" Inocencio		TIME VISIT/ INSPECTION COMPLETED:	03:10 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Administrator Remedios "Remy" Inocencio. The facility is licensed for a maximum capacity of 6 non-ambulatory residents. The facility has a waiver for 2 hospice residents. During today’s visit, the facility had a census of 5 residents, 3 ambulatory and 2 non-ambulatory. The Administrator for the facility is Remedios Inocencio and their certificate was valid and current. During today’s visit, LPA toured the facility and inspected each room of the facility, including resident rooms, bathrooms for resident and staff use, kitchen, garage, common areas, and outside space. No bodies of water were observed on the premises. LPA did not observe any aspects of delayed egress or secured perimeter. The facility was found to be clean, safe, and in good repair with no pathway obstructions. The facility’s water temperature was measured at 108.9 and 119.5 degrees Fahrenheit in common bathrooms for resident use. The facility’s internal temperature was measured at 73 degrees Fahrenheit. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. According to Remedios "Remy" Inocencio, no firearms or weapons are stored on the premises. LPA also observed locked storage for resident medications and resident and staff files. Resident medications are stored in their original container and labelled. LPA observed a minimum of a 2-day supply of perishable food and a 7-day supply of non-perishable food present at the facility. The facility refrigerator was kept at 33 degrees Fahrenheit, and the facility freezer was kept at 0 degrees Fahrenheit. LPA observed linens and hygiene products provided to the residents that are in good repair and sufficient to meet their needs. Staff present at the facility during the time of the inspection had a criminal background clearance, were associated to the facility, and had a first aid certificate. Continued on LIC809-C page…

Jennifer Lott	TELEPHONE: (619) 346-3976
Rebecca A Borunda	TELEPHONE: (619) 318-7620
	DATE: 01/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 01/08/2025

NARRATIVE

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LPA reviewed multiple resident and staff records. Each resident record was complete and contained a signed admission agreement, initial physician’s report and updated assessment, documents regarding safeguarding personal property, and personal rights. Each staff file was complete and contained a personnel record, first aid certificate, fingerprint clearance and association, and a health screening. LPA spoke with staff and residents present at the facility during the time of the inspection and those interviews did not reveal any licensing or regulatory concerns.

LPA was away from the facility for approximately one hour between 12:20pm and 1:20pm. LPA provided Administrator with an LIC9102TA Technical Assistance regarding documentation of staff training and an LIC9102TV Technical Violation regarding medication storage.

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, LIC9102TV, and the Licensee Appeal Rights (LIC9058 3/22).

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Rebecca A Borunda	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025

LIC809 (FAS) - (06/04)

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