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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880597
Report Date: 07/20/2022
Date Signed: 07/20/2022 11:35:29 AM

Document Has Been Signed on 07/20/2022 11:35 AM - 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:DIAMOND LIVING HOME CAREFACILITY NUMBER:
331880597
ADMINISTRATOR:ROSEMARIE SUMADSADFACILITY TYPE:
740
ADDRESS:4105 SHERMAN DRTELEPHONE:
(951) 324-1947
CITY:RIVERSIDESTATE: CAZIP CODE:
92503
CAPACITY: 6CENSUS: 5DATE:
07/20/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Estelita Umali, CaregiverTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to the facility to conduct a case management visit in conjunction with complaint 18-AS-20220627083050 to check on the health, safety, and welfare of residents in care. LPA met with Estelita Umali, Caregiver. LPA was informed that five (5) residents currently reside at this facility. There were two (2) staff on duty during the time of the visit and an Occupational Heath provider for a resident.

LPA observed all residents in care, facility utilities to be on and operating without issue. The facility has an adequate food supply and all residents have prescribed meds.

Based on the information obtained during today's visit, there were no deficiencies or citations issued per California Health & Safety Code and Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted with Caregiver Umali
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2022
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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