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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315001713
Report Date: 04/26/2023
Date Signed: 04/26/2023 12:26:12 PM


Document Has Been Signed on 04/26/2023 12:26 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
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



FACILITY NAME:DIAMOND OAKS RESIDENTIAL CAREFACILITY NUMBER:
315001713
ADMINISTRATOR:BUDAC, ABIGAILAFACILITY TYPE:
740
ADDRESS:501 BUTLER COURTTELEPHONE:
(916) 782-8177
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:6CENSUS: 5DATE:
04/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:CaregiverTIME COMPLETED:
12:30 PM
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On 04/26/2023 at 9:30 am, Licensing Program Analyst (LPA) Kevin Mknelly made an unannounced visit to conduct a required annual inspection. Upon LPA arrival, caregiver was present at facility and contacted Administrator , who arrived to assist.

There are currently 5 residents who reside at this facility, which is licensed for 6. This facility has a hospice wavier for 4 and currently has 4 residents on Hospice.

LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, and kitchen. Bathrooms and bedrooms were clean and in good repair. There is a locked storage for medications and toxins. Food supply is adequate for 2-day perishable and 7-day nonperishable. Smoke alarms were checked and in good working order. Fire drills are conducted as required. LPA observed an adequate amount of linens and found the first aid kit to be complete. Hot water temperature measures at the proper range. .

This facility is operating within the scope of their license.
As a result of todays inspection, observations, and interviews, no deficiencies were observed or cited.

Exit interview conducted with Licensee and report copy provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2023
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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