198320269-4-27-2023-11-AS-ARID-CRALAF-20230427083502

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320269
Report Date: 04/26/2023
Date Signed: 04/27/2023 08:35:20 AM

Document Has Been Signed on 04/27/2023 08:35 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	DIAMOND SENIOR LIVING INC.		FACILITY NUMBER:	198320269
ADMINISTRATOR:	DELAROSA, RICHARD		FACILITY TYPE:	740
ADDRESS:	2311 ROSWELL AVENUE		TELEPHONE:	(949) 490-0001
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90815
CAPACITY:	6	CENSUS: 6	DATE:	04/26/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:02 AM
MET WITH:	Richard Delarosa		TIME COMPLETED:	03:30 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	On 04/26/2023 at 8:00 AM Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced annual required visit using the new CARE Inspection Tool. LPA met with Licensee Richard Delarosa and explained the purpose of today’s visit. The facility is licensed to operate for five (5) ambulatory clients and one (1) bedridden client between the ages of 60 years and above. The facility is a single-story structure located in a residential neighborhood. It consists of the following: six (6) client rooms, one (1) staff room, one (1) office space in the living room area, (3) full bathrooms, living area, dining area, kitchen area and locked medication room. There is an outside yard landscape in good condition at time of visit and has an empty pond. The facility is equipped with cental heat/air conditioning, and water heater located in the laundry room. A three (3) car garage located in the front of the house. Garage includes an additional refrigerator/freezer and there is parking available for one car. (LPA) and Licensee inspected the physical plant. There were no bodies of water or obstructions on the premises,

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Antonine Richard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: DIAMOND SENIOR LIVING INC.	FACILITY NUMBER: 198320269
	VISIT DATE: 04/26/2023

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
26
27
28
29
30
31
32

All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for client personal belongings was observed. Bed linens, comforters, and bath towels were fully stocked at the time of visit. Bathrooms were clean and operational. Per California Code of Regulations Title 22 and California Health and safety Code. The hot water temperature in the bathroom tested at 117.8F degrees. A comfortable temperature was maintained throughout the facility. Emergency numbers are posted, in the kitchen. The facility has a land line. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies toxins and sharps objects were stored and not accessible to clients.
The kitchen was inspected and there is sufficient perishable and non-perishable food available. There is one (1) fire extinguisher fully charge located in the kitchen. smoke detectors and carbon monoxide were operable and working condition.

During the visit, LPA observed the facility infection control practices. LPA observed hand sanitizer available and temperature taken upon entry to the facility. LPA observed the facility has a 30-days supply of Personal Protective Equipment (PPE). There is a full first aid kit the medicine cabinet.
Per California Code of Regulations, Title 22 and California Health and Safety Code, there was a deficiency observed during visit. A person providing care shall be familiar with the facility's planned emergency procedures, shall be trained in first aid as required in Section 87465.

An exit interview held and plan of corrections was developed. A copy of the report and appeal rights were provided the Licensee.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Antonine Richard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 04/27/2023 08:35 AM - 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: DIAMOND SENIOR LIVING INC.	FACILITY NUMBER: 198320269
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87415(a)

Night Supervision

(a) The following persons providing night supervision from 10:00 p.m. to 6:00 a.m. shall be familiar with the facility's planned emergency procedures, shall be trained in first aid as required in Section 87465, Incidental Medical and Dental Care Services, and shall be available as indicated below to assist in caring for residents in the event of an emergency: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above. Tiffany Delarosa did not have the (CPR) training and First Aid training while on duty and on the premisesat all times. which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/05/2023
	Plan of Correction
1 2 3 4	Licensee will create a plan to ensure future compliance. Licensee will submit a plan of correction via email to LPA Antonine.Richard@dss.ca.gov

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Antonine Richard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3