<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601241
Report Date: 09/03/2021
Date Signed: 09/03/2021 05:27:01 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:DIMOND CAREFACILITY NUMBER:
015601241
ADMINISTRATOR:BLAIN, JOHN F.FACILITY TYPE:
740
ADDRESS:3003 FRUITVALE AVENUETELEPHONE:
(510) 436-0823
CITY:OAKLANDSTATE: CAZIP CODE:
94602
CAPACITY:30CENSUS: 25DATE:
09/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:John Blain, AdministratorTIME COMPLETED:
05:40 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 9/3/2021 starting at 3:15PM, Licensing Program Analysts (LPAs) Catherine Lin and Grace Luk arrived unannounced to conduct Infection Control Inspection. LPAs met with Administrator John Blain.

During the Infection Control Inspection, LPAs toured facility with administrator including but not limited to front entrance, screening station, bedrooms, common areas, dining areas, kitchen, and back yard. Facility has a sufficient 2-day perishable and one week non-perishable food supply. Facility has one entry point for universal screening for staff, residents and visitors. A sign-in policy, temperature check were observed at screening station and documented. LPAs were asked to sign-in before entering to facility. Cough/sneeze etiquette, face-covering, and hand washing posters were observed throughout the facility. Facility staff were observed to be wearing proper PPE. Facility has a 30-day supply of PPEs maintained at central location.

Facility has a mitigation plan, emergency disaster plan, and maintains records of routine screening for residents, staff and visitors, resident's changing of health conditions on file.



Exit interview conducted, and a copy of this report provided.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: Catherine LinTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2