486801837-7-21-2021-21-AS-BMOS-C5JNND-20210803103630

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486801837
Report Date: 07/21/2021
Date Signed: 07/21/2021 12:03:34 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/27/2021 and conducted by Evaluator Christopher Arnhold

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20210427111310

FACILITY NAME:	PARADISE VALLEY RESIDENTIAL CARE HOME		FACILITY NUMBER:	486801837
ADMINISTRATOR:	GADIA, EDWARD		FACILITY TYPE:	740
ADDRESS:	524 AMERICANO WAY		TELEPHONE:	(707) 344-4744
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94533
CAPACITY:	6	CENSUS: 4	DATE:	07/21/2021
		UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Edward Gadia		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff physically abused resident causing injury.

Staff is not serving food of the quality or quantity necessary to meet regulations.

INVESTIGATION FINDINGS:

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At approximately 11:10AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to complete an investigation into the above allegations. LPA met with Administrator Edward Gadia. The Department conducted an investigation into the above allegations and found them to be Unfounded. Based on interviews conducted, the statements were made duing hallucinations and were not true. LPA reviewed menus and observed lunch in progress. Food provided was within regulation.

This agency has investigated the above allegations. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

No citations issued.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

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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