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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700721
Report Date: 12/12/2023
Date Signed: 12/13/2023 02:50:15 PM


Document Has Been Signed on 12/13/2023 02:50 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 12/13/2023 02:45 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

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Licensing Program Analyst (LPA) Ruth Wallace arrived unannounced to conduct a required annual I year inspection visit. LPA met with Office Administrator and explained purpose of visit.

LPA toured physical plant with office administrator 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. The temperature inside the facility was measured at 74*F which is within the required range of 68*F and 85*F, or in areas of extreme heat the maximum shall be 30*F less than the outside temperature. The hot water was measured at 110.8*F and 110.5*F within regulatory range of is not less than 105*F and not more than 120*F. 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.

LPA observed fire extinguishers which were last inspected on 3/22/2023. 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 trashcans. LPA observed bacterial analysis of private water supply is being conducted annually and logged by a maintenance person. The facility has an approved Mitigation Plan.

Continued on 809-C Page Two
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 253-4746
LICENSING EVALUATOR NAME: Ruth WallaceTELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:
DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2023
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 2


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: 12/12/2023
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Continued from 809 - Page Two

LPA reviewed four resident and five staff files, including criminal record clearances. All staff are fingerprint cleared and associated to the facility.

LPA requested the following documents for facility file to be sent via email by December 19, 2023: LIC 308 Designation of Facility Responsibility, LIC 500 personnel report, LIC 610-E Emergency Disaster Plan, Liability Insurance, and Current Administrator Certificate.
ruth.wallace@dss.ca.gov

Per California Code of Regulations, Title 22 there were no deficiencies cited during today's inspection. An exit interview was conducted with administrator.

A copy of this report and (LIC 811 - Confidential Names) was left at the facility.

SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 253-4746
LICENSING EVALUATOR NAME: Ruth WallaceTELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2