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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610239
Report Date: 05/02/2023
Date Signed: 08/08/2024 01:41:58 PM

Document Has Been Signed on 08/08/2024 01:41 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
WOODLAND HILLS S.ASC, 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: 3DATE:
05/02/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Jeanette GonzalezTIME COMPLETED:
01:45 PM
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LPA Spaeth arrived and conducted an unannounced visit at 12:00 noon. LPA stated the purpose of the visit was regarding an incident report stating R1 had left the premises on 4/23/2023.

LPA conducted a tour of the facility with Administrator from 12:10 pm until 12:30 pm. LPA did not observe any health or safety issues during the tour. LPA observed R1's room is the master bedroom and an exit door is located in the room that leads to the backyard.

LPA reviewed R1's file from 12:30 pm until 12:40 pm. LPA observed the facility staffs' records from 1:15 until 1:20 pm and observed the staff are up-to-date with the required yearly training.

It was reported staff member (S1) was conducting a bed check on 4/23/2023 and observed R1 was not in R1's bedroom at 6:52 pm.. S1 and S2 searched for R1 within the facility and continued the search outside. However, S1 was not outside. A few minutes later, staff searched outside again and staff observed R1 was outside. On 4/24/2023 the Administrator asked where S1 had gone and S1 stated to the mall. However, Administrator stated that R1 was only outside for a few minutes and the mall is a twenty-minute walk from the facility to that location.

Upon speaking to Administrator, additional staff and facility procedures have been put in place to ensure S1's safety. The Administrator stated R1 verbally agreed to give Administrator permission to install an alarm on the exit door leading from R1's room to the backyard. Administrator stated R1 understands the alarm is to ensure R1's safety.

There are no deficiencies to report at this time. Exit interview was conducted and a copy of the signed report was given to the Administrator.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2023
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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