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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202843
Report Date: 04/12/2023
Date Signed: 04/12/2023 02:04:40 PM

Document Has Been Signed on 04/12/2023 02:04 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 MANOR II INC.FACILITY NUMBER:
435202843
ADMINISTRATOR:MIGUEL, LYNDAFACILITY TYPE:
740
ADDRESS:19133 MURIEL LN.TELEPHONE:
(408) 836-0828
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY: 6CENSUS: 5DATE:
04/12/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:38 AM
MET WITH:Licensee Lynda MiguelTIME COMPLETED:
11:30 AM
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Licensing Program Analysts (LPAs) Simi Rai and Manuel Monter conducted an unannounced case management visit. LPAs met with Administrator (ADM) Lynda Miguel. LPAs observed 0 out of 5 residents during the visit as they are currently attending Day Program.

During last visit 1/6/2023, LPA Rai observed the laundry room to have kitchen area, including a sink, stove and fridge. Administrator will submit new facility floor plan to LPA Rai by Friday, January 13, 2023.

Per ADM, the facility will remove the stove in the laundry room by February 28, 2023.

During today's visit, LPA Rai and LPA Monter observed the laundry room to include a sink and fridge but the stove was removed and a counter space was added in the existing space.

No deficiencies were cited per California Code of Regulations, Title 22.

This report was reviewed with Licensee Lynda Miguel and a copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2023
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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