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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202843
Report Date: 01/23/2025
Date Signed: 01/23/2025 04:12:09 PM

Document Has Been Signed on 01/23/2025 04:12 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/
DIRECTOR:		MIGUEL, LYNDAFACILITY TYPE:
740
ADDRESS:19133 MURIEL LN.TELEPHONE:
(408) 836-0828
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY: 6CENSUS: 6DATE:
01/23/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Staff, Jaylene MIguel and Melanie GavinaTIME VISIT/
INSPECTION COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit and met with Staff, Jaylene Miguel and Melanie Gavina. LPA Rai observed 1 staff who has obtained a Criminal Record Clearance. LPA Rai observed 0 residents at the facility as all 6 residents were attending day program.

During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents.

LPA Rai observed three cameras in the common areas facing the kitchen, living room and multipurpose room. Staff stated the cameras do not have an audio component. LPA Rai provided information regarding updating Plan of Operation for Video Surveillance use via email.

LPA Rai toured the facilty to include 3 resident rooms, 1 staff room, living room, multi-purpose room dining room, and kitchen. 3 Out of 3 resident bedrooms had available bedding, drawers, and functioning lights. The facility bathroom had available soap, paper towels, and trash cans with lids. The hot water temperature in the bathroom and kitchen sink ranged from 105.8 - 106.7 degrees F. Fire extinguisher was observed and inspected on 04/25/2024. Facility smoke detectors and carbon monoxide detectors were in working condition. The last disaster drills were conducted on 1/4/2025 and 1/5/2025.
LPA Rai reviewed facility records for 2 staff and 2 residents. LPA Rai reviewed resident medications and central stored medication records.

No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Staff, Jaylene Miguel and Melanie Gavina and a copy of the report was provided. LIC858 and LIC859 was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
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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