392700721-8-17-2021-27-AS-ABOE-C5YQMR-20210817121758

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 392700721
Report Date: 08/17/2021
Date Signed: 08/17/2021 12:18:12 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME:	DIAMOND CARE INC.		FACILITY NUMBER:	392700721
ADMINISTRATOR:	MURPHY, GLORIA		FACILITY TYPE:	740
ADDRESS:	7910 BRIGHT RD		TELEPHONE:	(209) 914-2859
CITY:	FRENCH CAMP	STATE: CA	ZIP CODE:	95231
CAPACITY:	14	CENSUS: 11	DATE:	08/17/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Zachary Murphy		TIME COMPLETED:	12:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 8/17/2021 Licensing Program Analyst (LPA) Ashley Boothe arrived unannounced to conduct a Required 1-year Annual inspection at 10:05am and met with Staff one (S1). LPA unable to contact Licensee for COVID screening prior to entry. LPA COVID screened upon entry to the facility. LPA was allowed entry into the facility that is licensed to serve a total capacity of 14 residents. Today's census is 11 of which 1 is Hospice. Five of five staff observed on site with criminal record clearance in Licensing Information System. LPA observed Administrator Certificate expires on 9/26/2022. Staff two (S2) arrived and accompanied LPA on facility tour. Administrator arrived and met with LPA after facility tour. LPA interacted with a random number of residents during this visit and observed residents. The physical plant was toured inside and outside to ensure the safety of the residents. LPA observed two facilities on two properties housing residents. LPA observed kitchen, garage, restrooms, bedrooms, and common living areas to be clean and in good repair. LPA observed five of eight resident rooms without required furnishings including chair, chest of drawers, and night stands. S2 stated they have just purchased some night stands. LPA observed a variety of missing items in the various rooms. The temperature inside the facility was measured at 70F which is within the required range of 68F and 85F, or in areas of extreme heat the maximum shall be 30F less than the outside temperature. The hot water was measured at 114.1F and 111.7F within regulatory range of is not less than 105F and not more than 120F. LPA observed the centrally stored medications, toxins, and knives stored in the locked garage office to be locked inaccessible to residents. The first aid kit was found in compliance containing at least the following: a current edition of an approved first aid manual, sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and Antiseptic solution. Continued on 809 C.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ashley Boothe	TELEPHONE: (916) 708-7751
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: DIAMOND CARE INC.	FACILITY NUMBER: 392700721
	VISIT DATE: 08/17/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA observed fire extinguishers, smoke and carbon monoxide detectors, central heating and air in the facility. LPA observed food supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days which shall be maintained on the premises at all times. LPA observed COVID precautions signs posted, restrooms stocked with paper towels, hand soap and touchless covered trash cans, no hand washing signs observed. Licensee stated he would put them up at sinks. Licensee stated 30 day supply of PPE stored is stored on site in his garage at home. LPA observed bacterial analysis of private water supply not conducted annually. Licensee stated all residents and staff are drinking water from water bottles at this time.

The facility has an approved Mitigation Plan.

Upon a file review the following items were discussed to be submitted to LPA by 8/30/2021:
Licensing fees
Administrative Organization LIC309
Designation of Administrative Responsibility LIC308
Personnel Report LIC500
Facility Floor Plan/Plot Plan LIC999
Qualifications of Administrator/Facility Manager
Control of Property (2)
Bacteriological Analysis of Private Water Supply
First aid/CPR certificates

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are being cited on the attached 809D during this visit. Civil penalties shall be assessed when the licensee fails to correct the violation and any appropriate extensions to the plan of correction due date. The Licensee was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. Exit interview held and a copy of report was given.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ashley Boothe	TELEPHONE: (916) 708-7751
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021

LIC809 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: DIAMOND CARE INC.	FACILITY NUMBER: 392700721
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/17/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87037(a)(3)(B)

(a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply:(3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of:(B)Bedroom furniture, which shall include, for each resident, a chair, night stand, a lamp, or lights sufficient for reading, and a chest of drawers. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on obsevation and interview, the licensee did not comply with the section cited above in five of eight rooms observed with out all elements of required furniture which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/07/2021
	Plan of Correction
1 2 3 4	The licensee agrees to submit proof of all resident rooms furnished with required furniture to LPA by POC due date.

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: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ashley Boothe	TELEPHONE: (916) 708-7751
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021

LIC809 (FAS) - (06/04)

Page: 5 of 5