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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300613175
Report Date: 11/24/2021
Date Signed: 11/29/2021 11:12:01 AM

Document Has Been Signed on 11/29/2021 11:12 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:DIANA'S GARDEN HOMEFACILITY NUMBER:
300613175
ADMINISTRATOR:LILIAN C. SALMORINFACILITY TYPE:
735
ADDRESS:2613 EAST DIANA PLTELEPHONE:
(714) 860-4203
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY: 6CENSUS: 5DATE:
11/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Norma PenanoTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit to the facility for the purpose of conducting a Required - 1 Year Annual inspection, with an emphasis on Infection Control due to the COVID-19 pandemic. LPA Martinez met with Staff Norma Penano and reason for the visit was explained. Staff Penano confirmed there are currently no cases or exposures of COVID-19 within the facility. LPA was screened upon entry into the facility.

LPA observed the required Department posting on COVID-19 precautions at entrance of facility. There is a sign-in procedure in place and hand sanitizer for use. LPA observed that staff were wearing face masks. The facility has an approved Mitigation Plan on file with CCLD. There were 3 Clients present during this visit. 2 Clients were at Program. LPA conducted a tour of the facility and made observations pertaining to the facility's Infection Control measures. LPA toured all resident rooms, all rooms were within regulations. 2 Clients were attending virtual Program during visit. Clients appeared clean and content with staff and the facility. All restrooms observed contained hand washing soap, toilet paper and paper towels and had the proper hand washing signs posted. Facility has operating smoke and carbon monoxide detectors. Facility has Fire Extinguishers which were charged. LPA observed a copy of Administrators Certificate which expires on 03/10/2022. The facility was equipped with sufficient hand hygiene supplies, cleaning and disinfecting provisions. Personal Protective Equipment (PPE) supply is available. The facility monitors the clients regularly for any COVID-19 symptoms/change of condition and documents. Facility has required Emergency Disaster Plan posted, and a secured location for client's medication and files. Facility has 30 days supply of medications for the clients. LPA reviewed client files. Client IPP's, emergency contact information and Physicians reports are current.

Based on observations made during today’s inspection, no deficiencies are being cited per Title 22, Division 6, of the California Code of Regulations. LPA reviewed this report with Administrator and a copy will be emailed.
SUPERVISORS NAME: Marina Stanic
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 11/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/24/2021
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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