Paradise Manor II

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Case Management - Incident visit in regards to an report the Department received on 02/13/2026. LPA met with Administrator, Lynda Miguel and stated the purpose of the visit. On 02/13/2026, the Department received a report stating on 02/10/2026, facility staff mishandled R1's personal item by losing R1's earring at the facility. During today's visit, LPA Rai conducted interviews with 2 staff (S1) including Administrator. S1 stated he/she was present at the facility and observed the incident occur at the facility on 2/10/2026. S1 stated on 2/10/2026, S1 noticed R1's earring was missing when S1 was assisting with R1's shower. S1 and ADM stated the facility staff searched the facility to find R1's earrings but the facility staff found the earring in a bowel-like container in the washing machine. S1 stated they assumed the earring may have fell into the clothes when R1 was removing the clothes prior to the shower and the earring was washed with R1's clothes in the washing machine. S1 stated the earring was returned to R1 the same day. During visit, ADM provided a picture of R1 that was taken at the adult day program today to show proof that R1 is wearing both earrings and the earrings are not lost. LPA Rai reviewed a picture taken of R1 in present time and observed R1 wearing both earrings in question. Continuation on LIC 809-C, Page 1 of 2. Page 2 of 2. Based on review of R1's facility records LIC 621 dated 12/15/2024, R1's earrings are recorded on the form. ADM stated the facility has a theft and loss policy and staff are trained in the related topics. Based on review of facility staff's job duties, facility staff are responsible for all residents' personal belongings. Based on review of staff training at random, 2 out of 2 staff obtained training on Facility Program Design and Theft Loss Policy provided during orientation. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Administrator, Lynda Miguel and a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 3, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit. LPA Rai met with Administrator Lynda Miguel and stated the purpose of today's visit. LPA Rai observed 2 staff who have obtained a Criminal Record Clearance. LPA Rai observed 1 resident at the facility and 5 residents were attending day program. The facility is vendorized by San Andreas Regional Center and is a level 5 facility. During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai observed 1 shed in the backyard which was locked and used for storage and not habitual space. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents.LPA Rai toured the facility to include 3 resident rooms, 1 staff room, living room, dining room and kitchen. 3 Out of 3 resident bedrooms had available bedding, drawers, and functioning lights. The facility bathroom had available soap, paper towels, and trash cans with lids. The hot water temperature in the bathroom and kitchen sink ranged from 116 - 117.6 degrees F. Fire extinguisher was observed and inspected on 04/08/2025. Facility smoke detectors and carbon monoxide detectors were in working condition. The last disaster drills were conducted on 1/3/2026 & 1/4/2026. LPA Rai observed a complete first aid kit at the facility. LPA Rai reviewed facility records for 3 staff and 3 residents. LPA Rai reviewed resident medications and central stored medication records. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Direct Care Staff, Melanie Gavina & Jaylene Miguel and a copy of the report was provided. LIC 858 and LIC 859 were provided.the state’s words, verbatim · CDSS document, Jan 8, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Case Management - Other visit to deliver an amended report to the facility. LPA met with Direct Care Staff, Melanie Gavina and stated the purpose of the visit. During visit, LPA Rai provided a copy of the original and amended report from LIC 9099 Complaint Investigation visit on 6/6/2025 was provided for Direct Care Staff, Melanie Gavina to review and sign the amended report. This report was reviewed with Direct Care Staff, Melanie Gavina and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 15, 2025

Allegation investigated: Resident sustained multiple injuries due staff's neglect of care and supervision.

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with Direct Care Staff, Melanie Gavina and stated the purpose of today’s visit. On 02/24/2025, the Department received a complaint with the above allegations. On 02/25/2025, the Department conducted an initial investigation at the facility. On 2/21/2025, the Department received an Incident Report from the facility stated on 2/20/2025, R1 was admitted to the hospital. Per Report, on 2/2/2025, facility staff observed R1 having difficulty breathing which resulted in facility staff seeking medical attention by calling 911. It was reported at the hospital that R1 was assessed to have a fractured clavicle. Continuation on LIC 9099-C, Page 1 of 3. Unsubstantiated Page 2 of 3. On 2/21/2025, R1’s responsible party (W1-W2) were interviewed. W1 stated they were unaware of R1’s fractured clavicle and concerned about R1 living at the facility. W1 and W2 stated R1 do not have any complaints or unexpected injuries at the facility. On 3/13/2025, the Department interviewed R1’s responsible party (W3). W3 stated R1 likes the facility and did not have any complaints about the facility. W3 stated there were no issues or unexplained injuries at the facility. On 2/26/2025, the Department interviewed 1 hospital staff (H1). H1 stated R1 did not have any bruises in the clavicle area and was not aware if the fracture was new or old. On 3/6/2025, the Department interviewed four facility staff (S1-S4). Four out of four staff stated on 2/20/2025, R1 was observed by facility staff to have shortness of breath which resulted in facility staff calling 911 to seek timely medical attention for R1. Four out of four staff stated they did not witness R1 falling or having other symptoms which may result in the fractured clavicle. Four of out four staff stated they did not physically abuse R1 or have not witnessed other staff abusing R1. Four out of four staff stated R1 does not have a history of self injurious behaviors and did not observe R1 scratching themselves. Four out of four staff stated R1 is able to express themselves when in pain. On 3/6/2025, the Department interviewed 4 residents (R1-R4). Two out of four residents were not able to answer or respond to the questions. Two out of two residents stated they have not seen R1 get hurt and no complaints about the facility staff. On 3/13/2025, the Department interviewed 3 staff at R1’s adult day program (D1-D3). D1 stated that R1 does not have self injurious behavior and R1 is able to express themselves in pain. Three out of three staff stated R1 did not have any falls or injures pertaining to the fractured clavicle. Three out of three staff stated they did not physically abuse R1 or witness other staff abusing R1. Based on R1’s hospital notes from 2/20/2025 through 2/26/2025, physician overseeing R1’s care in the hospital is R1’s primary care physician (MD). MD stated in three different progress notes on three different dates that the facility staff were taking care of R1 well and from outpatient clinic visits, physician has not noted any problems with facility caregivers. MD noted R1’s clavicle fracture is likely from a fall and does not suspected abuse. Page 3 of 3. Based on review of R1’s LIC 602A Physician’s Report dated 9/17/2024, R1 has a neurocognitive disorder, R1 is able to communicate needs and R1 has no history of skin condition or breakdown. Based on the interviews conducted with clients and staff and based on observation and records review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Direct Care Staff, Melanie Gavina and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jun 6, 2025 · control 26-AS-20250224090528

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit and met with Staff, Jaylene Miguel and Melanie Gavina. LPA Rai observed 1 staff who has obtained a Criminal Record Clearance. LPA Rai observed 0 residents at the facility as all 6 residents were attending day program. During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. LPA Rai observed three cameras in the common areas facing the kitchen, living room and multipurpose room. Staff stated the cameras do not have an audio component. LPA Rai provided information regarding updating Plan of Operation for Video Surveillance use via email. LPA Rai toured the facilty to include 3 resident rooms, 1 staff room, living room, multi-purpose room dining room, and kitchen. 3 Out of 3 resident bedrooms had available bedding, drawers, and functioning lights. The facility bathroom had available soap, paper towels, and trash cans with lids. The hot water temperature in the bathroom and kitchen sink ranged from 105.8 - 106.7 degrees F. Fire extinguisher was observed and inspected on 04/25/2024. Facility smoke detectors and carbon monoxide detectors were in working condition. The last disaster drills were conducted on 1/4/2025 and 1/5/2025. LPA Rai reviewed facility records for 2 staff and 2 residents. LPA Rai reviewed resident medications and central stored medication records. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Staff, Jaylene Miguel and Melanie Gavina and a copy of the report was provided. LIC858 and LIC859 was provided.the state’s words, verbatim · CDSS document, Jan 23, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit and met with Administrator, Lynda Miguel and Direct Support Staff, Melanie Gavina. LPA Rai observed 3 staff and 5 residents at the facility. During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. LPA Rai toured the resident bedrooms. 3 out of 3 resident bedrooms had available bedding, drawers, and functioning lights. The facility bathroom had available soap, paper towels, and trash cans with lids. The water temperature in the bathroom sinks ranged from 116.6F - 117.1F. The water temperature in the kitchen sink was 115.5F. LPA Rai observed the bathroom connected in a resident bedroom was locked. Per staff, the bathroom is not going through repairs and sometimes the residents use bathroom without staff's permission. LPA Rai checked bathroom sinks, toilet and shower in working condition. LPA Rai advised the staff to keep the bathroom door unlocked and accessible for residents to use. Fire extinguisher was observed and inspected on 05/10/2023. Facility smoke detectors and carbon monoxide detectors were in working condition. The last disaster drill was conducted on 1/7/2024. LPA Rai reviewed facility records for 3 staff and 3 residents. LPA Rai reviewed resident medications and central stored medication records. Deficiencies were cited per California Code of Regulations, Title 22, please see LIC 809-D. This report was reviewed with Direct Support Staff, Melanie Gavina. A copy of the report and Appeal Rights was provided.the state’s words, verbatim · CDSS document, Jan 29, 2024