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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336409054
Report Date: 08/04/2022
Date Signed: 08/24/2022 07:05:11 AM


Document Has Been Signed on 08/24/2022 07:05 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 RCFE OF MURRIETAFACILITY NUMBER:
336409054
ADMINISTRATOR:IARISH MARTINEZFACILITY TYPE:
740
ADDRESS:26973 HOLLY GROVE COURTTELEPHONE:
(951) 304-2162
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 6DATE:
08/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Administror, Agnes MartinezTIME COMPLETED:
04:25 PM
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Licensing Program Analyst (LPA) Janira Arreola made an unannounced visit to the facility for the purpose of an annual inspection focused on infection control. LPA was greeted by Administrator, Agnes Martinez who was informed of the purpose of the visit.

LPA conducted a tour of the interior and exterior of the facility. LPA observed COVID postings at the facility as well as a central entry point where symptoms screening are being done for visitors. LPA observed a 30-day supply of PPE equipment in the facility garage with N95 masks, face masks, gowns and hand sanitizer. The facility has (2) resident restrooms which posses enough hand hygiene supplies such as hand sanitizer, paper towels, and hand soap. LPA observed the (5) resident bedrooms that will be used as isolation rooms. (1) resident bedroom is shared, Administrator shared the care plan for those in the shared room to be isolated in the evident of a COVID positive. Administrator has a plan to attend to those in the isolation rooms, and monitor the residents for any changes in condition. There is a plan in place to clean the isolation rooms and the high touch surfaces. Staff poses training on the proper usage of PPE supplies and how to don and doff these supplies. Staff have leave they may use in case of a tested positive for COVID, and there is a procedure for staff to return to work once they are recovered.

No deficiencies were issued regarding the annual inspection at the time of the visit. An exit interview was conducted were this report was review and provided to facility Administrator, Agnes Martinez
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2022
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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