198601748-7-27-2022-11-AS-LMOA-CGQP2J-20220727105601

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198601748
Report Date: 07/22/2022
Date Signed: 07/27/2022 10:56:06 AM

Document Has Been Signed on 07/27/2022 10:56 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	DIAMOND STAR ASSISTED LIVING		FACILITY NUMBER:	198601748
ADMINISTRATOR:	MARIA TERESA MATIAS		FACILITY TYPE:	740
ADDRESS:	2038 W. 233RD STREET		TELEPHONE:	(424) 328-0468
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90501
CAPACITY:	6	CENSUS: 6	DATE:	07/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:33 AM
MET WITH:	MARIA MATIAS/NORMA GRANETA		TIME COMPLETED:	01:30 PM

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On 7/22/2022, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. Upon arrival, LPA called the facility to conduct a risk assessment. LPA spoke with Licensee Maria Matias, who confirmed the facility is Covid-19 free. LPA met with House Manager Norma Graneta shortly after and explained the purpose of today's visit.

Upon arrival at the facility, LPA met with Facility House Manager, Norma Graneta, who granted access and allowed LPA to enter the facility to conduct an annual inspection. Administrator Maria Matias joined the visit shortly after. The facility is licensed for six (6) non-ambulatory and approved for six (6) hospice waivers and there are two (2) hospice residents present during today’s visit. Annual Fees are current during today’s visit. The administrator’s certificate expires 10/3/2023.

During the visit, LPA toured the facility with HM Graneta and Administrator Matias. This facility consists of four (4) resident bedrooms, one (1) staff bedroom, two (2) full bathrooms, kitchen, living room/TV room, receiving room, dining area, shaded patio and a garage. Operable smoke detectors in bedrooms and hallways were observed. One carbon monoxide detector located near the main entrance door is operable. Two fire extinguishers last serviced on 8/17/2021 are located in the kitchen and hallway. The last facility fire drill was on 7/19/2022. LPA observed the facility is appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, and toxins were stored and not accessible to clients. The kitchen was inspected and there is sufficient perishable and non-perishable food available.

Report Continued in LIC 809-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: DIAMOND STAR ASSISTED LIVING	FACILITY NUMBER: 198601748
	VISIT DATE: 07/22/2022

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There are no pools or bodies of water on the premises. There are no firearms on the premises and other dangerous weapons. Potentially dangerous items are kept inaccessible to residents with dementia. Centrally stored medications are locked in a cabinet located in the receiving room. The first aid kit has all the required supplies. Toxic chemicals are locked in a cabinet in the kitchen. The facility has a written emergency disaster plan posted on the bulletin in the receiving room. The facility is maintained at a comfortable temperature. LPA observed hot water temperature is measured at 117.8 degrees Fahrenheit. There are working lights or lamps in each room at the time of visit. There are grab bars for each toilet and shower used by residents. Showers have non-skid mats.

During the visit, LPA observed the following to be in compliance: the facility's infection control practices; screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms; every staff was wearing a face covering; the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has a Mitigation Plan Report approved by CCLD.

Technical violation and assistance are being issued to the licensee:

Exit interview conducted. A copy of this report was provided to the Administrator Maria Matias.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

LIC809 (FAS) - (06/04)

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