<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486800368
Report Date: 10/24/2023
Date Signed: 10/24/2023 04:33:53 PM


Document Has Been Signed on 10/24/2023 04:33 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:PARADISE VALLEY ESTATESFACILITY NUMBER:
486800368
ADMINISTRATOR:YEE, KELLYFACILITY TYPE:
741
ADDRESS:2600 ESTATES DRIVETELEPHONE:
(707) 432-1100
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:743CENSUS: 70DATE:
10/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Elvira Gabionza (RN) MDS CoordinatorTIME COMPLETED:
05:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst Carol Fowler arrived unannounced for the purpose of conducting a 1-year annual inspection. LPA met with Elvira Gabionza (RN) MDS Coordinator and Agatha Narvaez-Okuda (LVN) Memory Care Supervisor and toured the Memory Care Unit Deer Creek and two assisted living units, Laurel Creek and Quail Creek. Assisted living kitchen and dining areas in all three units were inspected. LPA reviewed Administration; Care and Supervision; Medication; Food Service and Physical Plant.

LPA toured and inspected the building and grounds, which was found to be unobstructed, clean and at a comfortable temperature of 76 degrees F. There were no fire arms or weapons at the facility. The facility has an enclosed indoor swimming pool, which is inaccessible to residents from memory care. The amount of fresh and non-perishable foods were within regulation. There is a sufficient amount of hygiene products and linens for residents in care. Water temperature was tested and was within regulation, between 105 and 120 degrees F. All resident's bathrooms contained necessary grab bars and non-slip floors/mats. Facility has several fire extinguishers throughout the facility, which LPA observed charged and serviced 02/22/2023 Toxins are secured in locked cabinets or storage rooms throughout the facility and are inaccessible to residents. Facility currently has three hospice patients 1 in Quail Creek and 2 in Deer Creek.

Fire alarms are wired and tested once a year by an outside private company. LPA received copies of fire alarm and life safety system inspection certificates. Facility has 4 evacuation chairs located in stairwells of the second and third floors of Quail Creek Assisted Living. Medication was reviewed, centrally stored, and observed locked. .

LPA will return to facility to complete resident file review, complete interviews of staff/residents, and to conduct staff file review.

No deficiencies were found in the areas inspected, No citations issued during today's inspection.
Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Carol FowlerTELEPHONE: 707-588-5053
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1