331880597-6-2-2021-18-AS-KCLS-C49597-20210622194504

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880597
Report Date: 06/02/2021
Date Signed: 06/02/2021 11:52:50 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/24/2021 and conducted by Evaluator Christine Le

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210524111406

FACILITY NAME:	DIAMOND LIVING HOME CARE		FACILITY NUMBER:	331880597
ADMINISTRATOR:	ROSEMARIE SUMADSAD		FACILITY TYPE:	740
ADDRESS:	4105 SHERMAN DR		TELEPHONE:	(951) 324-1947
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92503
CAPACITY:	6	CENSUS: 6	DATE:	06/02/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Rosemarie Sumadsad		TIME COMPLETED:	12:02 PM

ALLEGATION(S):

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Resident is left in soiled clothing for a long period of time.
Staff did not seek medical attention for resident.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Christine Le and Anna Bueno conducted an unannounced visit to the facility to investigate the above allegations. LPAs initially met with caregiver Estelita Umali. The administrator Rosemarie Sumadsad arrived during the visit.

LPAs toured the facility, conducted interviews, and reviewed files. The first allegation indicates that at night Resident 1 (R1) was left in soiled clothing for a long period of time. LPAs were informed that R1 left the facility on 5/26/21 due to requiring a higher level of care. At night, R1 utilized a call light to request assistance from staff for incontinence care. LPAs tested the call light system and observed it was functional. LPAs interviewed residents and staff who confirmed that staff assists with the residents' incontinence care on a regular basis and residents are kept clean and dry. Interviews also confirmed that staff are available at night and check on the residents every two (2) hours. The second allegation indicates that the staff did not seek medical attention for R1. LPAs were informed that R1 was experiencing constipation and was prescribed medications for it. LPAs conducted interviews and was informed that R1 was hospitalized in May 2021 to

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Christine Le
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20210524111406

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: DIAMOND LIVING HOME CARE	FACILITY NUMBER: 331880597
	VISIT DATE: 06/02/2021

NARRATIVE

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be evaluated. LPAs also reviewed documentation and observed that R1 was receiving care for his/her constipation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated at this time.

No deficiencies were cited during this visit. An exit interview was conducted where this report was discussed and provided to the administrator.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Christine Le
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2021

LIC9099 (FAS) - (06/04)

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