<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006252
Report Date: 02/04/2025
Date Signed: 02/04/2025 04:55:43 PM

Document Has Been Signed on 02/04/2025 04:55 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:DIAMOND MANOR 2FACILITY NUMBER:
306006252
ADMINISTRATOR/
DIRECTOR:		HAMAMA, HAFEEZFACILITY TYPE:
740
ADDRESS:1631 W TEDMAR AVETELEPHONE:
(714) 502-0121
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY: 6CENSUS: 3DATE:
02/04/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Basyouny ElsayedTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On February 4th, 2025 Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of conducting an annual visit. Upon arrival LPA Vanegas was greeted and granted entry by Care Giver (CG) and explained the purpose of the visit. Upon entry LPA Vanegas set up equipment and began a tour of the facility and observed the following.

This a two storied home with seven bedrooms, four of which are resident bedrooms and three of which are staff bedrooms. There is three bathrooms two of which are resident bathrooms and one of which is staff bathroom the facility also has an attached two car garage. LPA Vanegas observed the kitchen to be clean and free of debris. LPA Vanegas observed kitchen to have a microwave, dishwasher, gas stove and refrigerator all tested to be operational and in good repair. LPA Vanegas observed a 2 day supply of perishable food and a 7 day supply of non-perishable food with a sufficient amount of emergency water.

LPA Vanegas observed all client bedrooms to have required furniture such as a bed, closet space, a lamp, chest drawers, and clean linens in good repair meaning no strains or tears. LPA Vanegas observed all resident bathrooms to be clean and free of debris and mildew. Toilet and water faucet tested operational. Water tested in between 110.8 and 111.0 degrees. All bathrooms consisted of the required furnishings such as functional grab bars slip resistant floor matts and shower chair.

LPA Vanegas observed fire extinguisher to be fully charged, LPA Vanegas observed smoke and carbon monoxide detectors to be functional and in good repair. LPA Vanegas observed first aid kit to contain all required material such as tweezers, scissors, adhesive tape, a thermometer, and clean bandages. LPA Vanegas observed outside of the facility and noted no obstructions along exit routes or ramps or inclines. Side doors are unlocked and self latching. Backyard is big enough to participate an outdoor activities and contains an outdoor shaded seating area.
CONTINUED ON LIC809C
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE: DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: DIAMOND MANOR 2
FACILITY NUMBER: 306006252
VISIT DATE: 02/04/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA Vanegas observed medications to be locked and inaccessible to residents in care. LPA Vanegas observed toxins and sharps to be inaccessible to clients in care and locked away. Toxins are stored separately from food items. LPA Vanegas reviewed emergency disaster plan, and infection control plan. Both items contained all required documentation.

LPA Vanegas was unable to review staff records due to facility staff not having it available for review. A deficiency was cited on today's date. LPA Vanegas reviewed three client records. All client records contained all the required documentation. LPA Vanegas reviewed medication administration record and medications with Administrator (AD) Basyouny Elsayed. Per LPA Vanegas review medications are not being documented correctly and medications are being transferred from one bottle to another a deficiency was cited on today's date.

Based on the observations made during today’s inspection, deficiencies are not being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights were left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 02/04/2025 04:55 PM - It Cannot Be Edited


Created By: William Vanegas On 02/04/2025 at 01:53 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: DIAMOND MANOR 2
FACILITY NUMBER: 306006252

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87412(a)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above as all staff records were not readily available for licensing review which poses a potential safety risk to persons in care.
POC Due Date: 02/18/2025
Plan of Correction
1
2
3
4
Licencee will create folders and make the accessable for review. Licensee will send proof of correct to LPA Vanegas by P.O.C due date.
Type B
Section Cited
CCR
87465(h)(5)
Incidental Medical and Dental Care Services
(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above as no medications were being documented that they were recieved and licensee has transfered previously prescribed medication into new containers of same medication which poses a potential health risk to persons in care.
POC Due Date: 02/18/2025
Plan of Correction
1
2
3
4
Licensee will document when medication is taken and make sure that they do not transfer previously prescribed medications into new containers. Licensee will send proof of correction via email to LPA by P.O.C due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Armando J Lucero
LICENSING EVALUATOR NAME:William Vanegas
LICENSING EVALUATOR SIGNATURE:
DATE: 02/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/04/2025


LIC809 (FAS) - (06/04)
Page: 3 of 3