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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 167200404
Report Date: 03/09/2024
Date Signed: 03/10/2024 09:00:37 PM


Document Has Been Signed on 03/10/2024 09:00 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
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:DIAMOND TERRACESFACILITY NUMBER:
167200404
ADMINISTRATOR:NORMAN, ROBERTFACILITY TYPE:
740
ADDRESS:600 E. 11TH STREETTELEPHONE:
(559) 585-8010
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY:38CENSUS: 23DATE:
03/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Facility Staff, Nicholas AlvidrezTIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Facility Staff, Nicholas Alvidrez, Continual Administrator's Certification Licensee Robert Norman expires 06/17/2025. There are currently 23 residents who reside at this home and there is 7 residents on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable.

Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The facility does not have documented disaster drills as required. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible. Water temperature measures 116 degrees.

LPA Hurt observed cleaning supplies in the kitchen near food items. Resident 1 does not have updated yearly Physician's Report as required. Resident 2 does not have required "Oxygen in Use" sign on door. Resident 3 does not have completed Admission Agreement in file. Staff does not have required / updated dementia training. Resident 4's medications are pre poured, and not in original containers. The facility entrance smells of urine, and several areas in the facility need dusting and deep cleaning.

The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22.

LPA requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing.

Exit interview conducted with Facility Staff, Nicholas Alvidrez, and copy of report left at facility
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2024
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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Document Has Been Signed on 03/10/2024 09:00 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA


FACILITY NAME: DIAMOND TERRACES
FACILITY NUMBER: 167200404

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87555(b)(25)
General Food Service Requirements
(b) The following food service requirements shall apply: (25) Soaps, detergents, cleaning compounds or similar substances shall be stored in areas separate from food supplies.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in LPA Hurt observed cleaning prodycts in facility kitchen area near food, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/10/2024
Plan of Correction
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Licensee will conduct training with facilty staff on proper chemical storage, and submit proof to LPA by POC date of 03/10/2024.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/10/2024 09:00 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710


FACILITY NAME: DIAMOND TERRACES
FACILITY NUMBER: 167200404

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87705(a)(5)


87705 Care of Persons with Dementia


(a) This section applies to licensees who accept or retain residents diagnosed by a physician to have dementia. Mild cognitive impairment, as defined in Section 87101(m), is not considered to be dementia.

(5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in Resident 1 does not have required yearly updated Physicians Report, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/23/2024
Plan of Correction
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Licensee will conduct audit of resident records, and ensure all residents have yearly updated Physicans reports and submit proof to LPA by POC date of 03/23/2024.
Type B
Section Cited
CCR
87705(a)(c)(3)
87705 Care of Persons with Dementia


(a) This section applies to licensees who accept or retain residents diagnosed by a physician to have dementia. Mild cognitive impairment, as defined in Section 87101(m), is not considered to be dementia.

such as wandering, aggressive behavior and ingestion of toxic materials.

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following:

(3) In addition to the on-the-job training requirements in Section 87411(d), staff who provide direct care to residents with dementia shall receive the following training as appropriate for the job assigned and as evidenced by safe and effective job performance:

(A) Dementia care including, but not limited to, knowledge about hydration, skin care, communication, therapeutic activities, behavioral challenges, the environment, and assisting with activities of daily living;

(B) Recognizing symptoms that may create or aggravate dementia behaviors, including, but not limited to, dehydration, urinary tract infections, and problems with swallowing; and

(C) Recognizing the effects of medications commonly used to treat the symptoms of dementia.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in no facility staff has required dementia training, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/23/2024
Plan of Correction
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Licensee will conduct required dementia training and submit proof to LPA Hurt by POC date of 03/23/2024.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5


Document Has Been Signed on 03/10/2024 09:00 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710


FACILITY NAME: DIAMOND TERRACES
FACILITY NUMBER: 167200404

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87411(a)(c)
87411 Personnel Requirements - General


(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services.

(b) All persons who supervise employees or who supervise or care for residents shall be at least eighteen (18) years of age.

(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in no facility staff has updated training , which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/23/2024
Plan of Correction
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Licensee will provide staff updated yearly training , and send proof to LPA by POC date of 03/23/2024.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5


Document Has Been Signed on 03/10/2024 09:00 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710


FACILITY NAME: DIAMOND TERRACES
FACILITY NUMBER: 167200404

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87465(h)(5)


87465 Incidental Medical and Dental Care


(h) The following requirements shall apply to medications which are centrally stored:


(5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in Resident 4's medication is pre poured more than 24 hours in advance, and out of the original container, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/23/2024
Plan of Correction
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Licensee will conduct Medication training with all facility staff, and send proof to LPA Hurt by POC date of 03/23/2024.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5