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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200884
Report Date: 04/25/2022
Date Signed: 04/25/2022 11:55:50 AM


Document Has Been Signed on 04/25/2022 11:55 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, 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: 6DATE:
04/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Ping Jing ZhaoTIME COMPLETED:
12:00 PM
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LPA Marrufo conducted an unannounced Required - 1 Year visit and met with Ping Jing Zhao. During visit, LPA Marrufo toured the inside and outside of the facility.

LPA Marrufo toured 6 out of 6 resident rooms, 1 out of 1 hallway bathrooms and 2 out of 2 resident bathrooms. LPA Marrufo observed there were hand washing and mask wearing signs in the hallways and bathrooms. LPA Marrufo observed there to be available soap and paper towels in the bathrooms. LPA Marrufo observed PPEs including a 30-day supply of N95 masks stored in the facility and a visitor screening log.

No deficiencies were cited at this time as per California Code of Regulations Title 22.

This report was reviewed with Ping Jing Zhao and a copy of the report was provided.
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2022
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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