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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445202559
Report Date: 06/14/2021
Date Signed: 06/14/2021 02:10:28 PM

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 VILLAFACILITY NUMBER:
445202559
ADMINISTRATOR:ERIN ROSE WILEYFACILITY TYPE:
740
ADDRESS:2177 17TH AVENUETELEPHONE:
(831) 475-1380
CITY:SANTA CRUZSTATE: CAZIP CODE:
95062
CAPACITY:58CENSUS: 25DATE:
06/14/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Emma LopezTIME COMPLETED:
02:11 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Ryker Heberle and Joanne Roadilla conducted an unannounced Case Management Legal/Non-Compliance (NCC) inspection. LPAs spoke to and discussed the purpose of this visit with Shift Supervisor Emma Lopez (SV). During the visit, LPAs observed 2 residents in dining room, 5 residents in their respective bedrooms, and 3 staff throughout the facility assisting residents. All staff present were fingerprint cleared.

At around 10:30am, LPAs toured the facility. COVID-19 related postings were observed by the entrance. LPA observed SV and staff following COVID-19 CDC/Public Health guidelines of wearing masks while around residents. Resident bedrooms were observed with furniture and linens.

During tour of facility, LPAs did not observe any guests of staff members present in the facility. During interviews with 3 staff members, staff did not indicate that they have had guests at the facility. SV stated that they have never observed staff to have guests at the facility. All staff were respectful with LPAs and compliant with CCLD inspection authority.

No deficiencies cited during today's inspection. Facility has been on NCC since 11/01/2018. Due to today's visit, the facility is being released from a Legal/Non-compliance plan. SV understood and agreed to remain in compliance with Title 22 Regulations.

Exit Interview conducted and copy of the report provided to Shift Supervisor Emma Lopez.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker HeberleTELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021
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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