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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700721
Report Date: 08/30/2024
Date Signed: 08/30/2024 02:39:56 PM


Document Has Been Signed on 08/30/2024 02:39 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



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: 15DATE:
08/30/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Richardson, AmberTIME COMPLETED:
02:48 PM
NARRATIVE
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LPA Albert Johnson made an unannounced POC visit to the facility to verify correction of citations issued during the complaint visit conducted on 6/14/2024.

LPA toured the facility, reviewed records and observed that the deficiency that was cited on 06/14/2024 ( 87465(c)(2) ) have been cleared. Deficiency cited under Title 22 Regulations have been cleared. Licensee complied with the terms of the POC by POC due date.

Citation given for infection control (87470 Infection Control Requirements). During the medication POC review the department discovered that the facility is cleaning and reusing PRN syringes for administration of control medications.

Advisories were given during today's POC visit.

87465 Incidental Medical and Dental Care

(h)The following requirements shall apply to medications which are centrally stored:(3) Each container shall carry all of the information specified in (6)(A) through (E) below plus expiration date and number of refills.

(5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.
Continued
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 08/30/2024
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(6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes:
(A) The name of the resident for whom prescribed.
(B) The name of the prescribing physician.
(C) The drug name, strength and quantity.
(D) The date filled.
(E) The prescription number and the name of the issuing pharmacy.
(F) Instructions, if any, regarding control and custody of the medication.

Exit interview conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/30/2024 02:39 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
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: 08/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/31/2024
Section Cited
CCR
87470(a)(3)(B)

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(a) A licensee shall ensure that infection control practices are maintained as follows:(3) In addition to Section 87629, Injections, all staff who are assigned to assist residents with the self-administration of injectable medication shall observe the following procedures:(B) A syringe and needle shall only be used once per injection on one resident and then properly disposed of in accordance with the California Code of Regulations, Title 8, Section 5193.

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The facility will use syringes one time for any medication administration. The Licensee will develop a plan to maintain compliance with this regulation and will submit a plan to the department by the POC date.
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This requirement was not met as evidenced by observation and interview conducted. The facility is cleaning and reusing syringes to administer controlled medication for hospice residents.
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If additional time is needed the licensee will request time to develop a plan by submitting a request by email to the department by the POC date.

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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: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2024
LIC809 (FAS) - (06/04)
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