197606998-9-13-2022-28-AS-CWOG-CJ8R8F-20220913124752

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197606998
Report Date: 09/13/2022
Date Signed: 09/13/2022 12:48:02 PM

Document Has Been Signed on 09/13/2022 12:48 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	DIAMOND CREST HOME CARE INC.		FACILITY NUMBER:	197606998
ADMINISTRATOR:	ROMULO AMARA		FACILITY TYPE:	740
ADDRESS:	1158 BEAVER WAY		TELEPHONE:	(909) 971-3755
CITY:	LA VERNE	STATE: CA	ZIP CODE:	91750
CAPACITY:	6	CENSUS: 5	DATE:	09/13/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Shelly Yamashiro		TIME COMPLETED:	01:00 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	Licensing Program Analyst (LPA) Christine Wong conducted an annual required visit. LPA met with caregiver Edwin Sison and explained the reason for the visit. Shortly after, the administrator Shelly Yamashiro arrived and assisted with the vlsit. LPA used the infection control tool to evaluate the facility. LPA observed the facility plant, COVID-19 procedures, reviewed residents' medications, observed food supply, and reviewed resident and staff files. The facility is a single story house and located in a residential neighborhood. The facility includes: Living Room, Kitchen, Dining area, four residents bedrooms, two bathrooms and an attached garage. All 4 resident bedrooms were toured. Resident bedroom#1 and #2 has one bed, one chair, one night stand, one drawer and required bed linen and furniture and sufficient lighting and closet space. Resident bedroom#3 and bedroom#4 has two beds, two night stands, two chairs and required bed linen and furniture and sufficient lighting and closet space. All 2 bathrooms were toured. Bathrooms are clean, sanitary and in a good working condition. Bathrooms have required grab bars and non-skid mats. The hot water in both bathrooms were tested between 110 and 112 degrees F. which is within the Title 22 Regulations. The refrigerator and kitchen cabinet in the kitchen and garage have sufficient for 2 days perishable and 7 days non-perishable food supply. All the appliances in the kitchen are working properly. The common area such as living room and dining area are clean and have required furniture. The front and back are maintained well and the back yard has a shaded area with table and chairs for residents to utilize. LPA also inspected carbon monoxide detectors and smoke detectors and they are all working properly. LPA reviewed all 5 resident files to confirm emergency contact is updated. LPA also reviewed 2 staff files to confirm health screenings and fingerprint clearances. Both staff are fingerprint cleared and their health screenings are updated on their staff personnel file. LPA also reviewed 5 residents medication and they all seemed updated. See LIC809C for Continuation.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: DIAMOND CREST HOME CARE INC.	FACILITY NUMBER: 197606998
	VISIT DATE: 09/13/2022

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Facility is currently following COVID 19 recommendations regarding COVID 19 signs throughout the facility, social distancing, the disinfecting products are available in the bathroom and the common area and facility is disinfected once a day, and the bathrooms have sufficient soap, paper towels, and signs, PPE supplies are sufficient for more than 30 days.

No deficiencies observed during the visit.

Exit Interview conducted. The copy of the report was provided to administrator Shelly Yamashiro.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022

LIC809 (FAS) - (06/04)

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