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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610239
Report Date: 08/04/2023
Date Signed: 08/08/2024 01:41:20 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: 4DATE:
08/04/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jeanette GonzalezTIME COMPLETED:
10:15 AM
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LPA Spaeth conducted an unannounced visit and was greeted by Administrator. LPA Spaeth stated the purpose of the visit was to follow up on an incident reported by facility on 08/01/2023. Facility reported that R1 attempted to destroy facility property and also threatened to harm Administrator.

LPA Spaeth and the Administrator toured the facility at 9:20 am until 9:50 am. LPA observed the Administrator and staff have taken proper precautions by removing decorative items to ensure the safety and welfare of all residents. During the tour, LPA did not observe any health or safety issues. All knives and cleaning solutions were safely locked in a hallway closet.

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: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2023
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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