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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700721
Report Date: 06/14/2024
Date Signed: 06/14/2024 03:34:53 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/20/2024 and conducted by Evaluator Kesha Lewis
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240220084349
FACILITY NAME:DIAMOND CARE INC.FACILITY NUMBER:
392700721
ADMINISTRATOR:CARIE SNODGRASSFACILITY TYPE:
740
ADDRESS:7910 BRIGHT RDTELEPHONE:
(209) 914-2859
CITY:FRENCH CAMPSTATE: CAZIP CODE:
95231
CAPACITY:16CENSUS: 14DATE:
06/14/2024
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Cristian VillacortaTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff gave authorized representative other residents medication upon discharge.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Lewis made an unannounced visit to the facility to deliver findings for the above allegation. LPA spoke with Administrator and explained the purpose of the visit.

Throughout the course of the investigation the Department interviewed staff and toured the physical plant, and reviewed documentation pertinant to the allegations listed above.

Allegation: Staff gave authorized representative other residents medication upon discharge.

Based on pictures provided by the reoprting party and interviews with the adminstrator and staff the allegation is SUBSTANTIATED.

See 9099C page......
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Kesha LewisTELEPHONE: (916) 764-1024
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/20/2024 and conducted by Evaluator Kesha Lewis
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240220084349

FACILITY NAME:DIAMOND CARE INC.FACILITY NUMBER:
392700721
ADMINISTRATOR:CARIE SNODGRASSFACILITY TYPE:
740
ADDRESS:7910 BRIGHT RDTELEPHONE:
(209) 914-2859
CITY:FRENCH CAMPSTATE: CAZIP CODE:
95231
CAPACITY:16CENSUS: 14DATE:
06/14/2024
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Cristian VillacortaTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not assist resident with oral hygiene care
Due to neglect, resident sustained pressure injuries
Due to neglect, resident was dehydrated
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Lewis made an unannounced visit to the facility to deliver findings for the above allegation. LPA spoke with Administrator and explained the purpose of the visit.

Throughout the course of the investigation the Department interviewed staff and toured the physical plant, and reviewed documentation pertinant to the allegations listed above.

Allegation: Staff did not assist resident with oral hygiene care, Due to neglect, resident sustained pressure injuries, Due to neglect, resident was dehydrated.

Based on documents provided by the facility and hospital recordsalong with interviews with the adminstrator and staff the allegation is UNSUBSTANTIATED.

See 9099C page......
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Kesha LewisTELEPHONE: (916) 764-1024
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20240220084349
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: DIAMOND CARE INC.
FACILITY NUMBER: 392700721
VISIT DATE: 06/14/2024
NARRATIVE
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Based on interviews with administrator and staff the facility provided documentation showing daily skin checks and oral hygiene. R1 liked to sit in a particular spot the facility was taking measures to increase movement and relive pressure.

A finding that the complaint allegation(s) are UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred, and the findings are unsubstantiated.


Exit interview conducted, copy of report provided.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Kesha LewisTELEPHONE: (916) 764-1024
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20240220084349
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: DIAMOND CARE INC.
FACILITY NUMBER: 392700721
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/17/2024
Section Cited
CCR
87465(c)(2)
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87465(c)(2) Incidental Medical and Dental Care. Once ordered by the physician the medication is given according to the physician's directions.
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The Administrator will developed a plan on how the facility will prevent medication being given to the wrong resident and hold a in service training for staff. Please send the agenda along with the sign-in sheet for the in-service. via email and fax to LPA Lewis by COB 06/17/2024.
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This requirement is not met as evidenced by: Based on interviews and records review, the Licensee did not ensure medications ordered for resident was given at discharge which poses an immediate health and safety risk to residents in care.
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Kesha.lewis@dss.ca.gov
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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 KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Kesha LewisTELEPHONE: (916) 764-1024
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20240220084349
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: DIAMOND CARE INC.
FACILITY NUMBER: 392700721
VISIT DATE: 06/14/2024
NARRATIVE
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Based on interviews with administrator and staff that confirm the wrong residents medication was given at discharge of R1 and records reviewed the Department finds the allegations to be Substantiated, meaning there was/is a preponderance of evidence that the event occurred.

Deficiencies are being cited as a result of today's visit.

See 9099D page....

Exit interview conducted, copy of report and appeal rights provided.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Kesha LewisTELEPHONE: (916) 764-1024
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5