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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336409054
Report Date: 05/18/2021
Date Signed: 05/19/2021 07:59:20 AM

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 RCFE OF MURRIETAFACILITY NUMBER:
336409054
ADMINISTRATOR:IARISH MARTINEZFACILITY TYPE:
740
ADDRESS:26973 HOLLYGROVE CTTELEPHONE:
(951) 304-2162
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 5DATE:
05/18/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Agnes Martinez, AdministratorTIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Deborah Mullen conducted an unannounced visit to conduct an annual inspection. LPA was granted entry to the facility by Patrick Gonzalez, Caregiver.

The home is a 5 bedroom, 2 bath home with a two dining areas, a sitting room and family room. The back yard is fenced and has tables, chairs and shade for residents comfort. Each bedroom is furnished with a bed, dresser, chair and appropriate lighting. The facility smoke detector and carbon monoxide detector was tested and is operational.

Food amount observed met the 7 days non-perishable and 2 days of perishable requirement. The medications are stored in a locked cabinet in the hallway, and chemicals are locked and stored in the garage.

Adults in the home have obtained the required Criminal Record Background Clearance and are associated to the facility.

LPA reviewed facility's infection control practices which appeared to be in compliance with Department of Public Health and Center for Disease Control.

No citations were observed or issued. An exit interview was conducted and a copy of this report was reviewed with and provided to Licensee, Agnes Martinez.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2021
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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