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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005258
Report Date: 03/26/2024
Date Signed: 03/26/2024 04:08:11 PM


Document Has Been Signed on 03/26/2024 04:08 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:DIAMOND SENIOR CARE 2FACILITY NUMBER:
306005258
ADMINISTRATOR:ANCA, NICOLAEFACILITY TYPE:
740
ADDRESS:13612 UTT DRIVETELEPHONE:
(714) 505-3885
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY:6CENSUS: 5DATE:
03/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Adela Albu - Administrator TIME COMPLETED:
04:25 PM
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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit for the purpose of conducting required annual. LPA was greeted and granted entry into the facility by Caregiver Jael Bitara. Administrator Adela Albu arrived shortly.

LPA and AD conducted a tour of the inside and outside of the facility, common areas, residents rooms, kitchen, and garage and observed the following: Structure. This is a one-story home. Facility is a 6- bedroom, 3-bathroom, one-story house with detached garage that is being used for storage. There is a back yard with a patio cover for the residents and a gated pool. LPA observed 3 staff and 5 resident present at the facility. The 5 residents bedrooms are spacious and will easily accommodate the residents’ furnishings. Lamps, chairs, linens, and storage for each residents bedroom inspected. Staff Bedrooms. LPA inspected the 1 staff bedroom. Bathrooms. Bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 109.1 and 109.7 F degrees. LPA inspected all rooms in the facility. Linens & Hygiene Supplies. New linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: Reviewed. Food Service. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher were observed and tested, including the wired smoke detectors/carbon monoxide detectors. Appliances. Stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen drawer. Toxins: observed locked under the sink. Medications are locked in kitchen cabinet. First-Aid Kit and Activity Supplies: observed and available.

At about 3:00PM, LPA reviewed 5 residents files and inspected medications for 3 residents.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea MendivilTELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:
DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/26/2024
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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: DIAMOND SENIOR CARE 2
FACILITY NUMBER: 306005258
VISIT DATE: 03/26/2024
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LPA reviewed 4 employee records. All employees present have a criminal record clearance and are associated to the facility. LPA observed records and all staff have a current First Aid certificate.


Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with the Administrator and a copy of this report was provided to the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea MendivilTELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024
LIC809 (FAS) - (06/04)
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