486800368-5-23-2024-21-AS-BMOS-D6DME9-20240619093220

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486800368
Report Date: 05/23/2024
Date Signed: 05/23/2024 03:51:18 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/09/2024 and conducted by Evaluator Julie Florio

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20240509082643

FACILITY NAME:	PARADISE VALLEY ESTATES		FACILITY NUMBER:	486800368
ADMINISTRATOR:	YEE, KELLY		FACILITY TYPE:	741
ADDRESS:	2600 ESTATES DRIVE		TELEPHONE:	(707) 432-1100
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94533
CAPACITY:	743	CENSUS:	DATE:	05/23/2024
		UNANNOUNCED	TIME BEGAN:	02:53 PM
MET WITH:	Kevin J. Hogan, Health Care Administrator		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Facility failed to meet residents incontinent care needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Julie Florio arrived unannounced at this facility to deliver findings of above allegation. LPA met with Administrator, Kevin J. Hogan. LPA conducted 10-day on 5/14/2024 and was informed that resident (R1) resides in the skilled nursing facility (SNF) portion of the community. LPA obtained documentation to confirm and cross reported allegation and concerns to Department of Public Health. Although CCL issues the license for Continuing Care Retirement Community (CCRC), CCL does not have jurisdiction to investigate above allegation. R1 as of 5/15/2024. no longer resides in the SNF. Based on record review, interviews conducted, and observations made, the allegation of facility failed to meet residents incontinent care needs is UNFOUNDED. A finding that the complaint is unfounded means that the allegation was false, could not have happened and/or is without a reasonable basis.

No Deficiencies cited during visit.

Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Julie Florio	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024

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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