<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603785
Report Date: 11/15/2024
Date Signed: 11/15/2024 05:37:33 PM

Document Has Been Signed on 11/15/2024 05:37 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:PARADISE CARE HOMESFACILITY NUMBER:
374603785
ADMINISTRATOR/
DIRECTOR:		EPPS, RHONDAFACILITY TYPE:
735
ADDRESS:2043 ALBERQUE CTTELEPHONE:
(619) 470-0504
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY: 4CENSUS: 4DATE:
11/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:House Manager Sonya Smith and Licnesee Garrick CharltonTIME VISIT/
INSPECTION COMPLETED:
05:50 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) Dang Nguyen conducted an unannounced visit to conduct a Required Annual Inspection. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with House Manager Sonya Smith. LPA also met with Licensee Garrick Charlton, who arrived later during the visit.

According to the facility’s license, the facility has a maximum capacity of four (4) clients, of whom all must be ambulatory. Per LIC602 Physician’s Reports, staff interviews, and LPA observation: During today’s inspection, there were a total of four (4) clients in care, and all were ambulatory. The facility’s license does not include endorsements for delayed-egress doors or secured perimeter, and neither of these were present.

During today’s visit, LPA performed a welfare check and interviewed multiple clients and staff. LPA reviewed the care records for all clients and personnel records for all active staff. LPA, accompanied by staff, also toured the interior and exterior of the facility, and inspected all common areas and client bedrooms.

The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were working. Extra supplies of linens, toiletries, and Personal Protective Equipment (PPE) were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. In the facility’s backyard, LPA observed unlocked/accessible the following “items that could pose a danger if readily available to clients”: one (1) full-length weed-destroying tool that had a sharp metal point with serrated teeth, and one (1) half-length hoeing tool with a metal blade and three metal prongs. [These items were immediately handed to facility staff to lock away.]


[CONTINUED ON LIC 809-C, 1 of 2]
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 7
Document Has Been Signed on 11/15/2024 05:37 PM - It Cannot Be Edited


Created By: Dang Nguyen On 11/15/2024 at 03:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: PARADISE CARE HOMES
FACILITY NUMBER: 374603785

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80087(g)
Building and Grounds
(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, Licensee did not ensure that items which could pose a danger if readily available to clients, were stored where inaccessible to clients. This posed an immediate health and safety risk to 4 of 4 clients (C1 through Client #4) in care.
POC Due Date: 11/15/2024
Plan of Correction
1
2
3
4
During today's visit, the metal tools were handed to facility staff to lock away, resolved the immediate risk. Licensee agreed to retrain all facility staff on what items constitute a hazard to clients if left accessible/unlocked, and to E-mail the training sign-in sheet to LPA, by 12/15/2024
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Lizzette Tellez
LICENSING EVALUATOR NAME:Dang Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2024


LIC809 (FAS) - (06/04)
Page: 2 of 7
Document Has Been Signed on 11/15/2024 05:37 PM - It Cannot Be Edited


Created By: Dang Nguyen On 11/15/2024 at 03:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: PARADISE CARE HOMES
FACILITY NUMBER: 374603785

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80066(a)(10)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (10) A health screening as specified in Section 80065(g).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on records review and manager interview, Licensee did not ensure that a health screening, as specified in Section 80065(g), was maintained in the personnel records of 2 of 8 staff (S1 and S2). Those posed a potential health and safety risk to persons in care.
POC Due Date: 12/15/2024
Plan of Correction
1
2
3
4
Licensee agreed to coordinate with S1 and S2 to have the LIC503 Health Screening form completed and signed by a doctor, to evidence that both staff are able to safely perform their job duties. Licensee agreed to E-mail the LIC503 for S1 and S2 to LPA, by the POC due date.
Type B
Section Cited
CCR
80075(b)(1)(A)1
Health-Related Services
(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. (1) In adult CCFs, facility staff who receive training may assist clients with metered-dose inhalers, and dry powder inhalers if the following requirements are met: (A) In ARFs, facility staff must receive training from a licensed professional. 1. The licensee shall obtain written documentation from the licensed professional outlining the procedures and the names of facility staff who have been trained in those procedures.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on records review and manager interview, for 2 of 4 clients (C1 and C2) who used inahler devices to receive medication, Licensee did not ensure that the staff who assisted them were trained by a licensed professional on inhalers, as evidenced in written documentation from the licensed professional. This posed a potential health risk to persons in care.
POC Due Date: 12/15/2024
Plan of Correction
1
2
3
4
Licensee agreed to coordinate with a licensed professional to have all current direct care staff trained on use of inhaler devices, and to document both the procedures staff are to follow and the names of the staff trained on them. Licensee agreed to E-mail proof of training completion to LPA, by the POC due date. Going forward, Licensee agreed to have a licensed professional review staff performance on inhalers at least once per year.
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:Lizzette Tellez
LICENSING EVALUATOR NAME:Dang Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2024


LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 11/15/2024 05:37 PM - It Cannot Be Edited


Created By: Dang Nguyen On 11/15/2024 at 03:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: PARADISE CARE HOMES
FACILITY NUMBER: 374603785

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1565(c)
Other Provisions
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of individuals served by the facility is not required during a drill. While a facility may provide an opportunity for individuals served by the facility to participate in a drill, it shall not require that participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and, if applicable, the names of staff participating in the drill.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on records review and manager interview, Licensee did not conduct disaster drills at least quarterly for each shift, This posed a potential safety risk to 4 of 4 clients (C1 through Client #4) in care.
POC Due Date: 12/15/2024
Plan of Correction
1
2
3
4
Licensee agreed to conduct, and document in writing, competion of three (3) disaster drills (one for AM shift, one for PM shift, and one for NOC shift). Licensee agreed to E-mail proof of drill completion to LPA, by the POC due date. Going forward, Licensee agreed to drill each shift at least once per quarter, and to vary the type of emergency covered from quarter to quarter.
Type B
Section Cited
CCR
80019(e)
80019 Criminal Record Clearance: “(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 80019(f)…” This requirement was not met, as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on records and manager interview, Licensee did not ensure that 1 of 1 volunteer (V1), who was subject to a criminal record review pursuant to Health and Safety Code Section 1522, requested and received a transfer of criminal record clearance, prior to volunteering at the facility. This posed a potential safety risk to 4 of 4 clients (C1 through Client #4) in care.
POC Due Date: 12/15/2024
Plan of Correction
1
2
3
4
CCLD records showed that V1 possessed a current Criminal Record Clearance. However, V1 was not yet associated to the facility roster. Licensee agreed to submit to CCLD a completed form LIC9182, with supporting documents, to begin the process of associating V1 to the facility’s roster, by the POC due date. Licensee agreed to not let V1 volunteer at the facility again until the Guardian system shows V1 on the facility’s roster.
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:Lizzette Tellez
LICENSING EVALUATOR NAME:Dang Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2024


LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 11/15/2024 05:37 PM - It Cannot Be Edited


Created By: Dang Nguyen On 11/15/2024 at 04:16 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: PARADISE CARE HOMES
FACILITY NUMBER: 374603785

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80092.1(k)(1)
General Requirements for Restricted Health Conditions
(k) If the licensed health professional delegates routine care, the following requirements must be met for health conditions specified in Sections 80092.3, 80092.4 and 80092.6 through 80092.11: (1) The licensee shall obtain written documentation from the licensed professional outlining the procedures and the names of the facility staff who have been trained in those procedures.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review and manager interview, for 1 of 4 clients (C1) with a restricted health condition, Licensee did not obtain written documentation from a licensed professional outlining the procedures and the names of the facility staff who have been trained in those procedures. This posed a potential health risk to persons in care.
POC Due Date: 12/15/2024
Plan of Correction
1
2
3
4
After completing a Restricted Health Condition Care Plan for C1's CPAP machine, Licensee agreed to arrange for a licensed professional train current facility staff on C1's CPAP machine and the Plan, capturing in writing the names of the staff who were trained and an outline of the procedures they are to follow. Licensee agreed to E-mail proof of training completion to LPA, by the POC due date. Alternatively, if C1's doctor discontinues the CPAP device, Licensee will E-mail LPA a copy of the discontinue order.
Type B
Section Cited
CCR
80092.2(a)

80092.2 Restricted Health Condtion Care Plan: "(a) If the licensee of an ARF chooses to care for a client with a restricted health condition, as specified in Section 80092, the licensee shall develop and maintain, as part of the Needs and Services Plan, a written Restricted Health Condition Care Plan..." This requirement was not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review and manager interview, for 1 of 4 clients (C1) with a restricted health condition, Licensee did not develop and maintain, as part of the Needs and Services Plan, a written Restricted Health Condition Care Plan. This posed a potential health risk to persons in care.
POC Due Date: 12/15/2024
Plan of Correction
1
2
3
4
Licensee agreed to first review CCR 80092.2, then write a Restricted Health Condition Care Plan for C1's CPAP machine, in consultation with C1's physician and San Diego Regional Center (SDRC) coordinator. The document will outline the procedures and the names of the facility staff who have been trained in those procedures. Licensee agreed to E-mail C1's completed and signed Restricted Health Condition Care Plan to LPA, by the POC due date. Alternatively, if C1's doctor discontinues the CPAP device, Licensee will E-mail LPA a copy of the discontinue order.
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:Lizzette Tellez
LICENSING EVALUATOR NAME:Dang Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2024


LIC809 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: PARADISE CARE HOMES
FACILITY NUMBER: 374603785
VISIT DATE: 11/15/2024
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
26
27
28
29
30
31
32
[CONTINUED FROM LIC 809]

The facility’s ambient internal temperature was complaint at 72 F. Hot water temperature at taps accessible to clients were complaint in temperature: Kitchen Sink was 110.5 F, Bathroom #1 Sink was 109 F, Bathroom #2 Sink was 109 F, and Bathroom #3 Sink was 108.5 F. Appliances to preserve perishable food were also compliant in temperature: Kitchen Refrigerator was 38 F and Kitchen Freezer was 0 F. Hallway Refrigerator was 40 F, and Hallway Freezers were both 0 F. There were at least (2) days of perishable food and at least seven (7) days non-perishable food present, all safely stored. Medications were labeled, as required, and stored in locked areas. Confidential records were stored in locked areas.

Per the Licensee, no firearms or ammunition were kept at the facility. The facility’s swimming pool, which had been fully drained of water, and was also fenced and locked per regulation. The facility's gas fireplace, which had been deactivated, was also screened. There were no open-faced heaters accessible to clients. Smoke detectors, carbon monoxide detectors, emergency lighting, night lights, and facility telephone were all working. The facility’s fire extinguisher was serviced within the last twelve (12) months. Training records showed that staff had received training on both PPE and the facility’s written Emergency Disaster Plan within the last year, as required. Required licensing postings were observed in visible areas of the facility. Licensee presented proof of current business liability insurance.

Manager interview and client records showed that Client #1 (C1) and Client #2 (C2) both used prescribed medication inhaler devices. [See LIC811 Confidential Names List for a description of select person identifiers used in this report.] However, Licensee did not have proof that a licensed professional trained the facility staff who assist C1 and C2 with their inhalers, on the correct use of such devices, as was required. C1 was also prescribed and issued a CPAP (i.e., an “inhalation assistive device”) to use at nighttime, which is a Restricted Health Condition, per regulation. However, Licensee did not possess a Restricted Health Condition Care Plan for C1’s CPAP, as was required. Licensee also did not have proof that facility staff who assist C1 with their CPAP received training on the device, as was required.


[CONTINUED ON LIC 809-C, 2 of 2]
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
LIC809 (FAS) - (06/04)
Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: PARADISE CARE HOMES
FACILITY NUMBER: 374603785
VISIT DATE: 11/15/2024
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
26
27
28
29
30
31
32
[CONTINUED FROM LIC 809-C, 1 of 2]

During a review of personnel and training records, LPA observed, and manager interview confirmed: Volunteer #1 (V1) possessed a current Criminal Record Clearance to work at care facilities, as required. However, Licensee did not ensure that V1 was associated to the facility’s roster, before V1 started volunteering with clients of the facility. For two of eight facility employees [Staff #1 (S1) and Staff #2 (S2)], Licensee did not possess a written pre-employment Health Screening completed and signed by a physician, as was required. While Licensee performed some disaster drills over the past year, they fell short of the required frequency of one drill per shift, per quarter.

Six (6) deficiencies were cited per California Code of Regulations, Title 22, and one (1) deficiency was cited per California Health and Safety Code (refer to the LIC 809-D pages). Plans of Correction were jointly developed with the Licensee.

An exit interview was conducted with House Manager Sonya Smith. A copy of this report, the LIC 809-D pages, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided to Licensee during today's visit.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
LIC809 (FAS) - (06/04)
Page: 7 of 7