079200787-10-13-2023-15-AS-YFLS-CYASWQ-20231207131442

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200787
Report Date: 10/13/2023
Date Signed: 10/13/2023 04:00:42 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/21/2023 and conducted by Evaluator Alona Gomez

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20230321085000

FACILITY NAME:	DIANA'S CARE HOME		FACILITY NUMBER:	079200787
ADMINISTRATOR:	REANO-AQUINO, GRACE		FACILITY TYPE:	740
ADDRESS:	27402 MANON AVENUE		TELEPHONE:	(510) 786-9982
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94544
CAPACITY:	35	CENSUS: 35	DATE:	10/13/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Grace Aquino, administrator		TIME COMPLETED:	03:05 PM

ALLEGATION(S):

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Resident not being provided appropriate dietary meals.

INVESTIGATION FINDINGS:

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On this day, Licenisng Program Analysts (LPAs) Luisa Fontanilla and Alona Gomez arrived at the facility to deliver finding for the above allegation and met with Administrator Grace Aquino. LPAs explained to Grace the purpose of the visit.

On 3/21/2023, Oakland Regional Office received a complaint with the allegation "Resident not being provided appropriate dietary meals."

On 3/22/2023, LPA L. Fontanilla conducted 10-day investigation. On 10/13/2023, LPAs L. Fontanilla and A. Gomez interviewed Administrator and 3 staff. All staff interviewed state the facility provided R1 with diabetic meals. However, staff interviewed state R1's family would bring foods such as pasta, burritos, nachos and frozen foods for R1. Staff also state that family was made aware about R1's dietary restrictions.
****continuation on Lic9099C"

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona Gomez	TELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

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 15-AS-20230321085000

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: DIANA'S CARE HOME	FACILITY NUMBER: 079200787
	VISIT DATE: 10/13/2023

NARRATIVE

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During the visit, Administrator showed LPAs a photo of R1 eating salad, beef, and Jell-O. However, the facility was unable to provide LPAs a copy of R1's special diet menu.

Based on interviews conducted and photo proof presented, the allegation that the resident was not provided appropriate dietary meals is unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

There is no deficiency noted.

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona Gomez	TELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

LIC9099 (FAS) - (06/04)

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