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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700226
Report Date: 05/01/2023
Date Signed: 05/01/2023 10:26:02 AM

Document Has Been Signed on 05/01/2023 10:26 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
HOME CARE SERVICES, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:PARADISE VILLAGE HOME CAREFACILITY NUMBER:
374700226
ADMINISTRATOR:WILLIAM H. LAWSONFACILITY TYPE:
300
ADDRESS:2700 EAST 4TH STREETTELEPHONE:
(619) 399-5423
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY: CENSUS: DATE:
05/01/2023
Required - 2 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Maria DiazTIME COMPLETED:
11:00 AM
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Home Care Services Bureau (HCSB) analyst Ruben Perez arrived at the business office of Paradise Village Home Care on 5/1/2023 for a biennial inspection. Upon arrival, the HCSB analyst identified himself and was greeted by Maria Diaz. The proper posting of business hours and license was observed. The analyst was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review the analyst discussed the findings of the inspection with Maria and informed the designee that no discrepancies were found.
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
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