331880597-11-12-2024-18-AS-ACAO-DAXVSJ-20241112154138

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331880597
Report Date: 11/12/2024
Date Signed: 11/12/2024 03:42:42 PM

Document Has Been Signed on 11/12/2024 03:42 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	DIAMOND LIVING HOME CARE		FACILITY NUMBER:	331880597
ADMINISTRATOR/ DIRECTOR:	GARY CANDIDATO		FACILITY TYPE:	740
ADDRESS:	4105 SHERMAN DR		TELEPHONE:	(951) 324-1947
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92503
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 4	DATE:	11/12/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:25 PM
MET WITH:	Estelita Umali, Caregiver		TIME VISIT/ INSPECTION COMPLETED:	03:50 PM

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On 11/12/2024, Licensing Program Analysts (LPAs), Andrei Castillo and Seo Jeon arrived at the facility unannounced to conduct the required annual inspection. Upon entry, LPAs were greeted by Caregiver Estelita Umali, and informed her of the purpose of the visit. Administrator Florina Candidato arrived a few minutes later. At the time of the visit, there were two staff members and four residents present. LPAs conducted a tour of the facility with the Administrator and Caregiver, reviewed facility documents and conducted interviews. The following is a summary of the visit:

Facility Overview: The facility is a one-story home with four bedrooms and two bathrooms, including a covered carport. Resident bedrooms had the required bedding, furniture, and lighting. Facility sketch, exit routes, personal rights, “If you See Something, Say Something,” LTC Ombudsman, complaint information and emergency phone numbers were observed posted in the facility. There were designated storage spaces for the residents and staff files, and were locked and inaccessible to residents in care.

Infection Control: There were hand hygiene and hand washing stations, and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements.

Physical Plant: Floors, windows and doors were clean and well-maintained. Furniture and fixtures were in good condition. The outdoor area was free of hazards and has a shaded area with outdoor furniture. Laundry equipment was in good working condition. LPA observed a fully charged fire extinguisher. Disinfectants, cleaning solutions, and sharp and dangerous objects were securely locked and inaccessible to residents. The smoke and carbon monoxide detectors were tested and operational, and the hot water temperature was

Cont. LIC 809-C

Rikesha Stamps	TELEPHONE: (951) 212-0616
Andrei Castillo	TELEPHONE: 951-248-2222
	DATE: 11/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: DIAMOND LIVING HOME CARE	FACILITY NUMBER: 331880597
	VISIT DATE: 11/12/2024

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measured at 115°F which is within the required limits. Safety night lights were observed throughout the facility. There were no bodies of water located on the property. According to the Administrator, there are no firearms or ammunition on the premises.

Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods.

Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. Administrator’s license is posted in the facility with an expiration date of 05/17/2025.

Record Review and Resident/Staff Files: LPA reviewed files for four staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Four resident files were reviewed and contained all required documentation.

Health-Related Services/Incidental Medical Services: All resident medications were securely locked. LPA reviewed medications for two residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for.

Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation showing the facility holds quarterly fire and earthquake drills, which was last conducted on 11/01/2024. All facility indoor and outdoor passageways and exits were clear of obstructions and or debris. LPA observed a refrigerator with non-perishable foods in the backyard patio with emergency supplies, food and water. There was a first aid kit with a manual.

No deficiencies were found during the visit. An exit interview was conducted, and a copy of this report was reviewed and given to Administrator, Florina Candidato.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Andrei Castillo	TELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024

LIC809 (FAS) - (06/04)

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