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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486800368
Report Date: 11/08/2024
Date Signed: 11/08/2024 04:17:39 PM

Document Has Been Signed on 11/08/2024 04:17 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/
DIRECTOR:
YEE, KELLYFACILITY TYPE:
741
ADDRESS:2600 ESTATES DRIVETELEPHONE:
(707) 432-1100
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 743TOTAL ENROLLED CHILDREN: 0CENSUS: 72DATE:
11/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Kelly Yee, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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At approximately 10:15 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and met with Kelly Yee, Administrator. Facility is a Continuing Care Retirement Community (CCRC) with a combined total of 72 residents currently residing in the independent living, assisted living, and memory care units. The Community is approved for a total capacity of 743 residents, of which 223 residents may be non-ambulatory. The Community has a Hospice waiver for 6 residents, and there is an approved delayed egress system in place in the memory care unit.

At approximately 10:30 AM, LPA requested staff and resident rosters. LPA experienced technical difficulties which made staff roster and Guardian verification take several hours to complete. LPA reported the issues to CCL Department managers and RM. Facility's staff are all background screened, cleared, and associated to the facility as required per regulation.

LPA will return at a later date to complete the annual inspection.

No deficiencies cited during today's visit.

Exit interview conducted with Administrator whose signature on form confirms receipt.

Bethany MoellersTELEPHONE: (707) 588-5040
Julie FlorioTELEPHONE: (707) 588-5026
DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2024
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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