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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405802288
Report Date: 07/05/2023
Date Signed: 07/05/2023 11:17:35 AM


Document Has Been Signed on 07/05/2023 11:17 AM - 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:PARADISE VALLEY CAREFACILITY NUMBER:
405802288
ADMINISTRATOR:CAROLA WHITEFACILITY TYPE:
740
ADDRESS:9525 GALLINA CTTELEPHONE:
(805) 468-4141
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:15CENSUS: 0DATE:
07/05/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:02 AM
MET WITH:Kara Freel-SparksTIME COMPLETED:
11:25 AM
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On 07/05/2023 at 11:02 am, Licensing Program Analyst (LPA) Chavez conducted an unannounced Case Management – Licensee Initiated visit. LPA met with Kara Freel-Sparks, daughter of Licensee, and explained the reason for the visit.

The purpose of this inspection is to document the closure of the facility and ensure all residents have been relocated. The facility closure was initiated by the licensee. The licensee notified Community Care Licensing Division (CCLD) on June 19, 2023, that the licensee intended to close the facility due to lack of ability to manage. The licensee communicated with residents and families and confirmed that residents would be relocated to other assisted living facilities.

LPA conducted a physical plant tour at 11:02 am and observed zero (0) residents occupying the facility. Resident rooms were empty of personal contents and there was no evidence that residents were living in the facility.

Exit interview conducted, Ms. Freel-Sparks states she is not authorized to sign on behalf of Licensee. Report emailed to the licensee.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:
DATE: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/05/2023
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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