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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200884
Report Date: 03/30/2026
Date Signed: 03/30/2026 02:37:19 PM

Document Has Been Signed on 03/30/2026 02:37 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/
DIRECTOR:		ZHAO, PING JINGFACILITY TYPE:
740
ADDRESS:1615 MIRAMONTE AVENUETELEPHONE:
(650) 961-4662
CITY:MOUNTAIN VIEWSTATE: CAZIP CODE:
94040
CAPACITY: 6CENSUS: 6DATE:
03/30/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Administrator, Ping Jing ZhaoTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On March 30, 2026, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced case management visit to follow up on an incident that occurred on 3/15/26. LPA met with Administrator, Ping Jing Zhao and explained the purpose of the visit.

The Licensee reported, on 3/15/26 at approximately 11:40am, staff went to Resident 1's (R1's) room to assist him/her with lunch, however discovered that R1 was not in his/her room. Staff searched the facility but was unable to locate R1. Administrator was notified and police was contacted to report R1 missing. Staff searched the neighborhood while waiting for the police's assistance. Police called shortly after and informed facility that the emergency department reported a patient matching R1's description. According to the hospital, a passerby saw R1 kneeling on the sidewalk and called emergency medical services. R1 was evaluated at the hospital and discharged back to the community.

During the visit, LPA interviewed administrator, toured the facility, and reviewed R1's file. According to R1's file reviewed, R1 has a diagnosis of dementia and is unable to leave the facility unassisted. R1's physician's report dated 4/17/25, notes that R1 does get confused/disoriented and does have a wandering behavior. According to the administrator, this is the first time R1 has eloped from the facility and neither administrator nor staff were aware that R1's physician documented R1 as having wandering behaviors. According to staff interviewed and observations, the door alarms were not working. According to staff, the receiver for the door alarms was not plugged in and has not been plugged in for a while.

(continue to 809C)
NAME OF LICENSING PROGRAM MANAGER: Cowan April
NAME OF LICENSING PROGRAM ANALYST: Komal Curley
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/30/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 HOME
FACILITY NUMBER: 435200884
VISIT DATE: 03/30/2026
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After the incident occurred, administrator reached out to the physician who provided facility with an updated physician's report for R1. According to R1's physician's report dated 3/21/26, it indicates R1 is now allowed to leave the facility unassisted and has occasional confusion. Nevertheless, due to the alarms not turned on and not operating, R1 who has a diagnosis of dementia, has wandering behaviors and is unable to leave the facility unassisted was able to leave the facility without supervision and was found at the hospital with minor abrasions to the knee.

Deficiency of the Residential Care Elderly California Code of Regulations, Title 22, Division 6 is observed and cited on a LIC 809D. Failure to correct the deficiencies may result in civil penalties. Copy of appeals rights is provided.

This report is reviewed and discussed with the Administrator; a copy is provided.
NAME OF LICENSING PROGRAM MANAGER: Cowan April
NAME OF LICENSING PROGRAM ANALYST: Komal Curley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/30/2026 02:37 PM - It Cannot Be Edited


Created By: Komal Curley On 03/30/2026 at 12:43 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: PARADISE CARE HOME
FACILITY NUMBER: 435200884

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/31/2026
Section Cited
CCR
87705(d)

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87705 Care of Persons with Dementia: (d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement...

This requirement is not met as evidenced by:
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Licensee/administrator plugged the receiver back in for the auditory device to monitor exits. LPA observed the auditory devices on both exit doors to be in good working condition. Deficiency cleared and corrected.
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Based on R1's physician's report dated 4/2025, R1 has a diagnosis of dementia, has wandering behaviors and is unable to leave the facility unassisted. According to staff interviewed, they were not aware that R1's physician's report notes that R1 has wandering behaviors. Based on observations and interviews, the staff had the receiver for the auditory device turned off.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Cowan April
NAME OF LICENSING PROGRAM MANAGER:
Komal Curley
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2026


LIC809 (FAS) - (06/04)
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