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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700957
Report Date: 03/20/2024
Date Signed: 03/20/2024 11:55:16 AM


Document Has Been Signed on 03/20/2024 11:55 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:SENIOR CARE @ DIAMOND OAKSFACILITY NUMBER:
342700957
ADMINISTRATOR:MACIUCA, ESTERAFACILITY TYPE:
740
ADDRESS:219 DIAMOND OAKS RD.TELEPHONE:
(916) 470-1416
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:6CENSUS: 6DATE:
03/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:CaregiverTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 3/20/2024 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with staff and explained the purpose of the visit. LPA requested for staff to notify Administrator that LPA is present at the facility to conduct an annual inspection. Licensee Estera Maciuca arrived to assist.

LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. The home was found to be clear, safe and sanitary. Residents were socializing and residents appeared to have their care needs met.

LPA reviewed 6 resident files and staff files. Files were complete

LPA requested licensee submit a copy of liability insurance.

A designee / backup Administrator, Claudia Olvera-- Martinez, has been dropped in Guardian. Licensee will submit a transfer request.

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report left at the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2024
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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