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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803635
Report Date: 03/11/2022
Date Signed: 03/11/2022 04:27:08 PM

Document Has Been Signed on 03/11/2022 04:27 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:PARADISE HOMEFACILITY NUMBER:
486803635
ADMINISTRATOR:TAGUPA, MARIA CARLAFACILITY TYPE:
735
ADDRESS:3809 POPPY HILL COURTTELEPHONE:
(650) 387-9488
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 4CENSUS: 4DATE:
03/11/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:43 PM
MET WITH:Selene Cruz-Astroga, LicenseeTIME COMPLETED:
04:36 PM
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Licensing Program Analysts (LPAs) Canela and Gonzalez-Campos arrived unannounced at Paradise Home for the purpose of a case management-incident inspection and met with Ana Morales-Astroga, House Manager. Licensee Selene Cruz-Astroga arrived later.

LPAs toured the facility and made observations. LPA Canela received notification of an incident that occurred on 03/09/2022 and was self-reported to the Santa Rosa Regional Office on 03/11/2022. The incident involved Staff (S1) and Clients (C1 & C2). Staff disclosed they heard a buzzing noise when S1 was interacting with C1 and S1 was seen with a unknown hand-held object. C1 & C2 were observed with similar marks on their bodies on 03/10/2022 by staff and Licensee was notified. Licensee took C1 & C2 to be seen by their medical physician for a check-up due to the incident. Additionally, Licensee made a report to Local Law Enforcement, APS, Ombudsman, and suspended S1 pending investigation.
Licensee stated it was determined by their medical physician that C1 & C2's marking's were potentially scratch abrasions. Licensee will hold an in-service training with all staff and stated S1 will not return to the facility.

Exit interview conducted with Licensee Selene Cruz-Astroga, whose signature on this document confirms receipt.

No deficiencies cited during this visit.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Karina Canela
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2022
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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