486803401-5-12-2025-21-AS-BMOS-DGNP9X-20250514110752

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803401
Report Date: 05/12/2025
Date Signed: 05/12/2025 11:40:18 AM

Unsubstantiated

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
03/24/2025 and conducted by Evaluator Ali Deniz

COMPLAINT CONTROL NUMBER: 21-AS-20250324121040

FACILITY NAME:	PARADISE VALLEY RESIDENTIAL CARE HOME #2		FACILITY NUMBER:	486803401
ADMINISTRATOR:	GADIA, EDWARD & LOURDES		FACILITY TYPE:	740
ADDRESS:	3204 ARROYO DRIVE		TELEPHONE:	(707) 759-5088
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94533
CAPACITY:	6	CENSUS: 6	DATE:	05/12/2025
		UNANNOUNCED	TIME BEGAN:	11:22 AM
MET WITH:	Licensee, Edward Gadia		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Uncleared staff working in the facility

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Deniz and Cuadra arrived unannounced to conduct a complaint investigation and deliver findings regarding the above allegations and met with Licensee, Edward Gadia.

The Department received an anonymous complaint allegation of uncleared staff working in the facility. Per anonymous complainant, uncleared staff (unknown names) are illegally working as caregivers and they are not trained and holding illegal status, but Licensee allegedly reshuffles staff between their three care homes whenever there is a state visit. On 3/27/25, LPAs conducted 10-day visit to the facility made observations, reviewed records and conducted interviews with staff and residents. During tour of the facility, LPAs made observations and observed S1 and S2 providing care and supervision to residents in care. Based on interviews conducted with staff (S1 and S2) indicates that they are live-in staff who resides in caregiver’s room #8 as indicated in their fire clearance. Based on records review, the facility provided LPAs with LIC500 Personnel report dated 12/31/2024 confirmed that staff listed are associated to the facility through Guardian system.
Continued on LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Ali Deniz	TELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025

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 21-AS-20250324121040

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 RESIDENTIAL CARE HOME #2	FACILITY NUMBER: 486803401
	VISIT DATE: 05/12/2025

NARRATIVE

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Continued from LIC9099...

Interviews conducted with staff and residents in care did not reveal any leading evidence that could indicate the presence of any uncleared staff at this facility. Therefore, LPAs was unable to determine if allegation could happen at a prior date of any uncleared staff who could been present providing care and supervision during the time of the alleged incident. A finding that the complaint allegation occurs of uncleared staff working in the facility is unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted and copy of report given to Licensee.

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Ali Deniz	TELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025

LIC9099 (FAS) - (06/04)

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