<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600650
Report Date: 11/15/2021
Date Signed: 11/15/2021 02:06:29 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/02/2020 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20201202160551
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:
11/15/2021
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:S-1TIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff yelled at resident.
Facility staff threatened resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Elizabeth Irra conducted a subsequent unannounced visit to investigate the above allegations. The initial investigation was conducted by LPA Wong on 12/11/2020. LPA was allowed entry by S-1 and LPA explained the purpose of today's visit.

The following occurred today, LPA obtained the Client Roster and Staff Roster, interviewed Staff #1 (S-1) and Staff #3 (S-3). LPA was unable to interview Staff #2 (S-2) as S-2 is no longer working for this facility as a result of the above allegations. LPA also interviewed Client #1 (C-1), Client 4 (C-4) and Client 5
(C-5). LPA was unable to interview C-2 and C-3 as they are non-verbal.

Refer to LIC 9099C for the continuation of this report.

Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 28-AS-20201202160551
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: DIAMOND GEM HOME CARE
FACILITY NUMBER: 198600650
VISIT DATE: 11/15/2021
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
Allegation: Facility staff yelled at resident. During this investigation, LPA reviewed records and obtained relevant documentation. LPA interviewed Staff #1 (S-1) and Staff #3 (S-3). LPA was unable to interview Staff #2 (S-2) as S-2 is no longer working for this facility as a result of the above allegation. LPA also interviewed Client #1 (C-1), Client 4 (C-4) and Client 5 (C-5). LPA was unable to interview C-2 and C-3 as they are non-verbal. (1) staff out of (2) witnessed S-2 yelling at C-1. (1) staff out of (2) was not present at the time of this incident and is the staff whom replaced S-2's position. Per staff interviews, S-2 was terminated from working at this facility as S-2 also admitted to yelling at C-1. Client interviews revealed that they witnessed S-2 yelling at C-1. Staff and Client interviews and documentation reviewed corroborate this allegation.

Allegation: Facility staff threatened resident. During this investigation, LPA reviewed records and obtained relevant documentation. LPA interviewed Staff #1 (S-1) and Staff #3 (S-3). LPA was unable to interview Staff #2 (S-2) as S-2 is no longer working for this facility as a result of the above allegation. LPA also interviewed Client #1 (C-1), Client 4 (C-4) and Client 5 (C-5). (1) staff out of (2) witnessed S-2 threatening C-1. (1) staff out of (2) was not present at the time of this incident and is the staff whom replaced S-2's position. Per staff interviews, S-2 was terminated from working at this facility as S-2 also admitted to threatening C-1. Client interviews revealed that they witnessed S-2 threatening at C-1. Staff and Client interviews and documentation reviewed corroborate this allegation.

Based on LPA’s observations and interview which was conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated.

California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited. Refer to attached LIC 9099D.

Note: LPA was having technical difficulties during this visit.

Exit interview conducted, a copy of the report and appeal rights were provided to S-1.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20201202160551
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: DIAMOND GEM HOME CARE
FACILITY NUMBER: 198600650
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/15/2021
Section Cited
CCR
80072(a)(1)
1
2
3
4
5
6
7
Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:
(1) To be accorded dignity in his/her personal relationships with staff and other persons.

This standard is not met as evidence by:
1
2
3
4
5
6
7
Facility Administrator to conduct an in-service for staff on Client Rights and Zero Tolerance.

***Facility Administrator conducted a training on Client Rights and Zero Tolerance for staff on 01/07/2021***. POC CORRECTED.
8
9
10
11
12
13
14
Per Staff and Client interviews, S-2 yelled at C-1.
8
9
10
11
12
13
14
Type B
11/15/2021
Section Cited
CCR
80072(a)(3)
1
2
3
4
5
6
7
Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not
1
2
3
4
5
6
7
Facility Administrator to conduct an in-service for staff on Client Rights and Zero Tolerance.

***Facility Administrator conducted a training on Client Rights and Zero Tolerance for staff on 01/07/2021***. POC CORRECTED.
8
9
10
11
12
13
14
limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.

This standard is not met as evidence by: Per Staff and Client interviews, S-2 threatened C-1.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3