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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006252
Report Date: 12/30/2024
Date Signed: 12/30/2024 12:09:57 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/20/2024 and conducted by Evaluator Andrea Mendivil
COMPLAINT CONTROL NUMBER: 22-AS-20241220165902
FACILITY NAME:DIAMOND MANOR 2FACILITY NUMBER:
306006252
ADMINISTRATOR:HAMAMA, HAFEEZFACILITY TYPE:
740
ADDRESS:1631 W TEDMAR AVETELEPHONE:
(714) 502-0121
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY:6CENSUS: 3DATE:
12/30/2024
UNANNOUNCEDTIME BEGAN:
07:58 AM
MET WITH:Basyony Elsayed, Licensee TIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Licensee Corporation is not in good standing
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an uannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facility by Basyouny Elsayed and explained the reason for the visit.

The Department recieved a complaint on 12/20/2024 and the initial 10 day visit was conducted on 12/30/2024. During the visit LPA Mendivil reviewed files and interviewed staff. Regarding the allegations that icensee corporation is not in good standing the investigation revealed the follwing:

It was alleged that the licensee's corporation Diamnond Manor 2 LLC is not in good standing with the Secretary of State. LPA Mendivil reviewed California Secretary of State Business Search website, based on information provided on the website the licensee Diamond Manor 2 LLC is in good standing.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2024
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 5
Control Number 22-AS-20241220165902
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 MANOR 2
FACILITY NUMBER: 306006252
VISIT DATE: 12/30/2024
NARRATIVE
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Therefore based on preponderance of evidence through records reviewed and interviews the allegation that Licensee Corporation is not in good standing is determined to be UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis.

An exit was conducted and a copy of this report was provided to facility representative.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/20/2024 and conducted by Evaluator Andrea Mendivil
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20241220165902

FACILITY NAME:DIAMOND MANOR 2FACILITY NUMBER:
306006252
ADMINISTRATOR:HAMAMA, HAFEEZFACILITY TYPE:
740
ADDRESS:1631 W TEDMAR AVETELEPHONE:
(714) 502-0121
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY:6CENSUS: 3DATE:
12/30/2024
UNANNOUNCEDTIME BEGAN:
07:58 AM
MET WITH:TIME COMPLETED:
11:30 AM
ALLEGATION(S):
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 facility lacks liability insurance
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facility by Basyouny Elsayed, Licensee and explained the reason for the visit.

The Department received a complaint on 12/20/2024 and the initial 10 day visit was conducted on 12/30/2024. During the visit, LPA Mendivil interviewed staff. Regarding the allegation that facility lacks liability insurance, the investigation revealed the following:

LPA Mendivil interviewed Basyouny Elsayed, Licensee and it was indicated the liability insurance lasped after a Change of Ownership. Licensee stated they forgot to renew liability insurance once the facility was licensed under the new corporation on 03/20/2024.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20241220165902
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 MANOR 2
FACILITY NUMBER: 306006252
VISIT DATE: 12/30/2024
NARRATIVE
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Therefore based on the preponderance of evidence through interviews the allegation facility lacks liability insurance is determined to be SUBSTANTIATED, meaning the complaint allegation was valid and that a violation has occurred

The following is being cited per California Code of Regulations Title 22 Division 6 Chapter 8.

An exit interview was conducted and a copy of this report and appeal rights were provided to Licensee.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20241220165902
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 MANOR 2
FACILITY NUMBER: 306006252
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/06/2025
Section Cited
HSC
1569.605
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all residential care facilities for the elderly … shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000)
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Licensee obtained liability insurance within the parameters of HSC while LPA Mendivil was at the facility. POC cleared as of 12/30/2024.
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 in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee. This requirement was not met as evidence by Licensee stated they did not pay renewal for liability insurance. This poses a potential safety risk to those in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5