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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 445202851
Report Date: 08/24/2022
Date Signed: 08/24/2022 03:09:25 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/16/2022 and conducted by Evaluator Ryker Heberle
COMPLAINT CONTROL NUMBER: 26-AS-20220816154953
FACILITY NAME:PARADISE ASSISTED CARE CORPFACILITY NUMBER:
445202851
ADMINISTRATOR:WILEY, ERIN ROSEFACILITY TYPE:
740
ADDRESS:2177 17TH AVETELEPHONE:
(831) 475-1386
CITY:SANTA CRUZSTATE: CAZIP CODE:
95062
CAPACITY:58CENSUS: 25DATE:
08/24/2022
UNANNOUNCEDTIME BEGAN:
10:19 AM
MET WITH:Christina RivasTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Facility doesn't have hot water
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ryker Heberle opened an initial complaint investigation regarding the above allegations. LPA met with Administrator Christina Rivas (Administrator).

During the visit LPA toured facility and interviewed 3 residents. 3 out of 3 residents interviewed stated that the water in their bathrooms work properly and are adequately warm. During tour of the facility, LPA measured water temperature in 6 rooms. The temperature readings were as follows: Room 25: 109.5*F, Room 27: 111.7*F, Room 20: 114.6*F, Room 10: 105.1*F, Shared downstairs restroom: 101.6*F, Room 4: 97.9*F.

The Department has conducted an investigation of the above allegations. Based on LPA's observations, and interviews conducted, the preponderance of evidence standard has been met. Therefore, the Department found the above allegation to be SUBSTANTIATED. Deficiencies are being cited. See LIC 9099-D. Exit interview conducted with Administrator Christina Rivas. A copy of this report, along with the facility's appeals rights were provided electronically due to printer error.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker HeberleTELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 26-AS-20220816154953
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 ASSISTED CARE CORP
FACILITY NUMBER: 445202851
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/31/2022
Section Cited
CCR
87303(e)(2)
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87303 - Maintenance and Operation - (e)(2) - Faucets used by residents for personal care... shall deliver hot water... to attain a temperature of not less than 105*F. This requirement was not met as evidenced by:
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Licensee to purchase a new water heater with a larger capacity tank. Licensee to provide proof of purchase and installation to be sent to the department by POC due date.
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Based on LPA observation: 2 out of 6 faucets in resident personal care bathrooms delivered hot water at a temperature of less than 105*F. This poses a potential health and safety risk to residents receiving care.
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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.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker HeberleTELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
LIC9099 (FAS) - (06/04)
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