336409054-8-11-2023-18-AS-JROO-CULQDG-20230811120442

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336409054
Report Date: 08/11/2023
Date Signed: 08/11/2023 12:06:30 PM

COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/11/2023 12:06 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 AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	DIAMOND RCFE OF MURRIETA		FACILITY NUMBER:	336409054
ADMINISTRATOR:	IARISH MARTINEZ		FACILITY TYPE:	740
ADDRESS:	26973 HOLLY GROVE COURT		TELEPHONE:	(951) 304-2162
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92563
CAPACITY:	6	CENSUS: 5	DATE:	08/11/2023
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator Agnes Martinez		TIME COMPLETED:	12:15 PM

NARRATIVE

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On 8/11/2023, at 9:30 a.m., Licensing Program Analyst (LPA) Janette Romero arrived unannounced at the facility to conduct an annual required visit. LPA was greeted and granted entry by Caregiver Patrick Gonzales who was informed of the purpose of visit. Administrator Agnes Martinez arrived during the visit.

The facility is approved for 6 non-ambulatory/bedridden residents, and has a hospice waiver for five (5) residents. During the visit, there was five (5) residents and (2) staff present. LPA toured the facility’s interior and exterior, and observed the following:

Kitchen: LPA observed kitchen area to be clean. Food is stored in a safe and healthful manner. LPA observed the facility had a 2-day supply of perishable foods and 7-day of non-perishable food items. Knives/sharp instruments are secured in a locked kitchen cabinet under the sink.

Dining and Living room: LPA toured the dining and living/family room area. LPA observed area to be clean and furniture in good condition. LPA observed residents sleeping in their rooms and in common areas. Home temperature was set to 78-degrees Fahrenheit. Carbon monoxide and smoke detector were tested and functioning properly.

Records: Staff present have a criminal record clearance on file and are associated to the facility. Record reviews revealed CPR/first aid certification for all staff has expired as of 5/28/2023. Deficiency cited.

Continued on LIC809-C..

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Janette Romero	TELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

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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Document Has Been Signed on 08/11/2023 12:06 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: DIAMOND RCFE OF MURRIETA	FACILITY NUMBER: 336409054
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/11/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/21/2023 Section Cited CCR 87465(a)(5)	1 2 3 4 5 6 7	(a) A plan for incidental medical and dental care... (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee agreed to provide staff training regarding proper medication dispensing. Proof of correction to be submitted to CCL by close of business on POC due date.
	8 9 10 11 12 13 14	Based on observation and interview, Licensee did not comply with the above due to LPA observing resident medication is transferred onto an unlabeled/unidentifiable container. This poses a potential health/safety risk to residents in care.	8 9 10 11 12 13 14
Type B 08/21/2023 Section Cited CCR87411(a)(1)	1 2 3 4 5 6 7	(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee agreed to renew CPR/First Aid certification for all facility staff and provide proof of correction to CCLD by close of business on POC due date.
	8 9 10 11 12 13 14	Based on interview and record review, Licensee did not comply with the above due to record review revealing administrator and 4 staff do not possess current CPR/first aid certification, which poses a potential health/safety risk to residents in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Janette Romero	TELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

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 AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: DIAMOND RCFE OF MURRIETA	FACILITY NUMBER: 336409054
	VISIT DATE: 08/11/2023

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Centrally Stored Medications: LPA observed a first aid kit with required components. Medications were secured in a hallway cabinet. LPA reviewed physical medications for all residents as well as Medication Administration Record. LPA observed that facility staff transferred resident medications out of their original containers and placed them onto clear unlabeled/unidentifiable containers for all five (5) residents. Deficiency cited.

Bedrooms: Resident bedrooms were each furnished with a bed, chair, closet, clothing storage and lighting.

Bathrooms: Bathrooms have a working toilet, wash basin, and were equipped with a grab bar in the shower. The hot water temperatures measured at 106- and 108-degrees Fahrenheit. The facility has clean towels, blankets, and linen, available in different colors for the residents in care.

Laundry/Garage: LPA toured the laundry room and garage. Washing machine and dryer are in good repair. Cleaning solutions and chemicals are secured in locked laundry room. Emergency food supplies, water, PPE, and incontinent supplies are stored in the garage.

Yard/Outside Area: All outdoor pathways were free of obstructions. No bodies of water were observed. There were no firearms or ammunition observed at the facility, and LPA was informed the facility will not store firearms or ammunition on the premises.

During today’s visit, LPA observed two deficiencies faulting the facility.

An exit interview was conducted, and a copy of this report was reviewed and provided to Administrator Martinez along with an LIC809-D and Appeals Rights.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Janette Romero	TELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

LIC809 (FAS) - (06/04)

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