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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601748
Report Date: 10/02/2024
Date Signed: 10/02/2024 04:30:26 PM

Document Has Been Signed on 10/02/2024 04:30 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:DIAMOND STAR ASSISTED LIVINGFACILITY NUMBER:
198601748
ADMINISTRATOR/
DIRECTOR:
MARIA TERESA MATIASFACILITY TYPE:
740
ADDRESS:2038 W. 233RD STREETTELEPHONE:
(424) 328-0468
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY: 6CENSUS: 5DATE:
10/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:14 AM
MET WITH:Administrator Assistant Rosemarie FamisanTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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On 10/02/24 at 11:14 AM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with Administrator Assistant Rosemarie Famisan. Facility is licensed to serve six (6) non-ambulatory residents and has an approved hospice waiver for six residents. Two residents are currently receiving hospice services.

This is a single story home consisting of: five bedrooms (two shared rooms, two private rooms, and one staff room), two bathrooms, living room, kitchen with dinning area, office, laundry area (laundry area located in garage), patio, covered jacuzzi with two car attached garage. The facility is clean, sanitary, and in good repair.

The Administrator accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards.

Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Resident bathrooms were checked. Toilets and water faucets worked properly and grab bars were secure. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked.
Continue to LIC-809C.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: DIAMOND STAR ASSISTED LIVING
FACILITY NUMBER: 198601748
VISIT DATE: 10/02/2024
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Common areas were clean and clear of hazards and doorways were free of obstructions.

LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxins were kept in locked storage cabinet. First Aid kit was available. One fire extinguisher, last serviced August 19, 2024 was observed in the hallway neat the kitchen. Staff tested the carbon monoxide detector and smoke detectors in the house. Both devices were functional.

Five staff records were reviewed, five out of five staff records had required criminal record clearances or criminal record exemptions.

Five resident records were reviewed and, five out of five resident records had medical assessments and pre-appraisal or reappraisals. Two residents’ medication was reviewed.

No deficiencies are being cited.

An exit interview was conducted and a copy of this report was discussed and left with Administrator Assistant Rosemarie Famisan.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
LIC809 (FAS) - (06/04)
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