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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604829
Report Date: 08/13/2026
Date Signed: 08/13/2026 03:53:55 PM

Substantiated


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
06/22/2026 and conducted by Evaluator Angelica Boyles
COMPLAINT CONTROL NUMBER: 08-AS-20260622160555
FACILITY NAME:PARADISE SENIORS LIVING VALLEYFACILITY NUMBER:
374604829
ADMINISTRATOR:CARDONA, BRENDAFACILITY TYPE:
740
ADDRESS:8117 JEFFERSON STTELEPHONE:
(619) 750-8488
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY:4CENSUS: 3DATE:
08/13/2026
UNANNOUNCEDTIME BEGAN:
08:22 AM
MET WITH:Licensee Brenda CardonaTIME COMPLETED:
02:46 PM
ALLEGATION(S):
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Facility staff did not provide a full refund
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced visit to the facility to deliver investigative findings regarding the above mentioned allegation. LPA identified herself, explained the purpose of the visit and nature of the complaint to Licensee Brenda Cardona.

On June 22, 2026 the Department received this complaint which alleged facility staff did not provide a full refund. The Department’s investigation included record reviews, as well as interviews with staff and outside sources.

(Continued on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Angelica Boyles
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 08-AS-20260622160555
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 SENIORS LIVING VALLEY
FACILITY NUMBER: 374604829
VISIT DATE: 08/13/2026
NARRATIVE
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(Continued from LIC9099)

Based upon records and interviews, the following timeline was revealed: Resident #1 (R1) passed away at the facility on 10/11/25. [See LIC811 Confidential Name List for a description of select person identifiers used in this report.] R1’s responsible party removed R1’s personal belongings on 10/12/25. On 10/17/25 a medical supply company removed an electrical hospital bed that was used by R1. The facility issued a check of $4,290.00 on 11/21/25. This amount is reflective of the amount from date 10/17/25, however, the hospital bed is not a personal belonging of R1’s and belongs to the medical supply company. R1’s personal belongings were removed on 10/12/25. Therefore, the difference of $1,532.55 is owed to R1’s responsible party. Additionally, the facility did not issue the refund within 15 days, as required.

The Department has investigated the allegation that facility staff did not provide a full refund. Based upon the information obtained during this investigation, it is determined that the preponderance of evidence was met to support or corroborate this allegation and therefore deemed substantiated. One deficiency is being cited (see attached LIC9099-D) and a plan of correction was jointly developed with the Licensee.

An exit interview was conducted with Licensee Brenda Cardona, to whom a copy of this report and the Licensee’s Rights (LIC9058 01/16) were provided at the conclusion of the visit.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Angelica Boyles
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20260622160555
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 SENIORS LIVING VALLEY
FACILITY NUMBER: 374604829
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/21/2026
Section Cited
HSC
1569.652(c)
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1569.652 Termination of admission agreement upon death of resident; removal of resident's property; refund of fees paid...
(c) A refund of any fees paid in advance covering the time after the resident's personal property has been removed from the facility shall be issued...within 15 days
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Licensee agreed to pay R1's responsible party the remaining amount owed of $1,532.55 and submit proof to LPA by POC due date.
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This requierment was not met as evidenced by:
Based on records reveiwed and LPA interviews, Licensee did not issue a full refund within 15 days of R1's personal belongings being removed. This poses a personal rights risk to persons in care.
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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: Simon Jacob
LICENSING EVALUATOR NAME: Angelica Boyles
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3