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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604593
Report Date: 10/26/2022
Date Signed: 10/26/2022 05:31:16 PM


Document Has Been Signed on 10/26/2022 05:31 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 HILLS BOARD AND CAREFACILITY NUMBER:
374604593
ADMINISTRATOR:FEREDE, ABEBEFACILITY TYPE:
740
ADDRESS:1580 ANTOINE DRTELEPHONE:
(619) 519-2591
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY:6CENSUS: 0DATE:
10/26/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Masho Woldegerima, LicenseeTIME COMPLETED:
04:42 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) Dawn Segura conducted an announced Pre-Licensing visit. LPA was met by Applicant, Masho Woldegerima, and granted entry into the facility. The purpose of today’s visit was to inspect the facility to ensure that the facility is in compliance with California Code of Regulations, Title 22, Division 6. The fire inspection was completed on August 24, 2022, and the facility was approved for 4 ambulatory and 2 non-ambulatory residents.

During today's visit, LPA, accompanied by applicant, Masho Woldegerima, and Abebe Ferede toured the facility inside and outside and inspected all rooms. The facility was found to be in good repair with no pathway obstructions. Residents' bedrooms were observed to be clean and contained required furnishings. Toilets were found to be in working order. Facility temperature was 72 degrees F during the visit. Hot water temperature in a resident bathroom measured at 119.9 degrees F. Hazardous and/or toxic chemicals were stored and secured in locked cabinets that are inaccessible to residents. There were locked spaces for storage of medications and resident and staff records. There was a first aid kit present in the facility. Activities and sufficient space in which to conduct activities were present. Fire extinguishers were observed in the facility. Hard-wired smoke and carbon monoxide detectors were present and were recently inspected by the local fire authority. No pools or bodies of water were observed near or on the premises. According to the applicant, no firearms and/or ammunition were present or will be stored in the facility. Non-perishable food items were present and appropriately stored in the facility. LPA conducted Component III with the applicant and administrator. The topics discussed were continuing operation requirements, record keeping/reporting, and physical plant compliance.

Pre-Licensing is complete, and no deficiencies were cited during the visit. It is recommended that this facility be licensed pending final review and approval. An exit interview was conducted, and copies of this report and Applicant Rights were provided to the applicant at the conclusion of the visit.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022
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 1