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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610239
Report Date: 09/01/2022
Date Signed: 09/01/2022 11:43:43 AM

Document Has Been Signed on 09/01/2022 11:43 AM - 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:DIAMOND CARE FACILITYFACILITY NUMBER:
197610239
ADMINISTRATOR:WHITE-TILLMAN, WILDAFACILITY TYPE:
735
ADDRESS:1632 AMARGOSA DR.TELEPHONE:
(661) 916-9090
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY: 4CENSUS: 0DATE:
09/01/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Wilda White-Tillman and Wayne WhiteTIME COMPLETED:
11:45 AM
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LPA Spaeth arrived to the facility and was greeted by Wilda White-Tillman and Wayne White for the scheduled pre-licensing and Comp III visit. Upon entering the facility, LPA observed the COVID signs on the front door and LPA's temperature was recorded and LPA answered the required COVID questions.

At 9:30 am, LPA conducted the Comp III presentation and the facility tour began at 10:30 am. LPA observed the kitchen and family room are combined. The large room contains comfortable seating along with a dining room table. At 10:36 am, LPA recorded the water temperature which was 110 degrees F. LPA observed a two day supply of perishable food item such as fresh fruits, vegetables, and dairy products in the refrigerator. The freezer section contained frozen meats. The pantry contained a seven day supply of canned goods. The fire extinguisher is located in the kitchen.

LPA observed comfortable seating in the backyard and the side gate leading to the front yard was not locked. The closet within the kitchen was locked and contained cleaning supplies. A closet at the entrance to the facility contained the knives, a locked safe which will be used to secure P&I funds, a cabinet for safely storing residents' medications, emergency food, emergency water, and the first aid kit. LPA also observed a six-month supply of PPE. The smoke/carbon monoxide detectors were tested at 10:45 am and were properly working.

There are four bedrooms in the facility and all contained a bed, linens, night stand, night lamp, chest of drawers, and a closet. There are three bathrooms which all contained slip resistant mats, wash your hands sign, paper towels, hand soap, and a trash can. The laundry room was locked and LPA observed laundry detergent, washer and dryer. A locked door lead to the garage and an additional freezer contained frozen food items.

There are no deficiencies to report at this time. Exit interview was conducted, appeal rights discussed, and a copy of the report was given to the Administrator.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2022
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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