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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600650
Report Date: 10/27/2023
Date Signed: 10/30/2023 07:40:00 AM

Document Has Been Signed on 10/30/2023 07:40 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:DIAMOND GEM HOME CAREFACILITY NUMBER:
198600650
ADMINISTRATOR:REMY COLEMANFACILITY TYPE:
735
ADDRESS:2468 LENNOX STTELEPHONE:
(909) 626-5307
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY: 6CENSUS: 5DATE:
10/27/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Elizabeth StacyTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Elizabeth Irra conducted a case management visit to obtain additional information pertaining to Client #1/C-1’s incident report dated 10/17/23 (alleged suspected abuse). LPA met Elizabeth Stacy and explained the purpose of today’s visit.

LPA reviewed C-1’s and Staff #1 (S-1) files and obtained relevant documentation. Per Ms. Stacy, C-1 was relocated on 10/17/23 (evening) per C-1’s family member's request (San Gabriel Pomona Regional Center is aware of relocation). S-1 was placed on leave pending further investigation. Pomona Police Department was contacted and a report was filed. LPA may contact Administrator for additional information and may conduct interviews.

Exit interview conducted and a copy of this report provided to Elizabeth Stacy.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2023
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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