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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200884
Report Date: 04/15/2024
Date Signed: 04/15/2024 12:50:15 PM


Document Has Been Signed on 04/15/2024 12:50 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131



FACILITY NAME:PARADISE CARE HOMEFACILITY NUMBER:
435200884
ADMINISTRATOR:ZHAO, PING JINGFACILITY TYPE:
740
ADDRESS:1615 MIRAMONTE AVENUETELEPHONE:
(650) 961-4662
CITY:MOUNTAIN VIEWSTATE: CAZIP CODE:
94040
CAPACITY:6CENSUS: 5DATE:
04/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Lei (Becky) BiTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Administrator Becky Bi.

During visit, LPA Marrufo toured the facility inside and out. LPA Marrufo toured the facility kitchen area and the refrigerators in the garage. LPA observed a perishable food supply of at least two days and a non-perishable food supply of at least 7 days.

LPA Marrufo toured two out of two hallway bathrooms and observed the water temperatures to be at 119 F and 120 F. LPA observed each bathroom had available soap and paper towels and had working lights.

LPA Marrufo tested the smoke detectors and carbon monoxide detectors in the hallways and bedrooms, and found them all to be functioning when tested. LPA Marrufo toured 6 out of 6 resident bedrooms and each bedroom had available bedding and clothing storage and had available lighting.

LPA toured the outside area and observed the outdoor area to be clear of obstructions.

LPA Marrufo reviewed the resident and staff records during visit.

No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator Becky Bi and a copy of this report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/15/2024
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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