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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005829
Report Date: 03/04/2024
Date Signed: 03/05/2024 01:51:04 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/05/2024 01:51 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:PARADISE RESIDENTIAL CAREFACILITY NUMBER:
397005829
ADMINISTRATOR:ADA P. OSUKAFACILITY TYPE:
735
ADDRESS:2673 EAST JUNCTION DRIVETELEPHONE:
(209) 910-0900
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY: 6CENSUS: 5DATE:
03/04/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Ada OsukaTIME COMPLETED:
04:00 PM
NARRATIVE
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Unannounced case management visit made out to this facility on 03/04/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Ada Osuka, who was briefly interviewed.
Current census was 5 residents, of which, 4 were out at their respectable day programs at this time.
The purpose of this case management visit was to follow up and complete the annual that was originally conducted on 10/25/2023. This LPA was unable to review the facility files for personnel and residents on that date.
A review of (3) facility resident files was conducted and noted on the following LIC 858.
A review of (3) facility personnel files was conducted and noted on the following LIC 859.

There were no additional deficiencies that were observed and cited during today's case management-annual continuation visit.

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2024
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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