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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701301
Report Date: 07/06/2026
Date Signed: 07/06/2026 02:32:40 PM

Document Has Been Signed on 07/06/2026 02:32 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 HOME FOR SENIORS IIFACILITY NUMBER:
392701301
ADMINISTRATOR/
DIRECTOR:		VILLAMIL, EMMAFACILITY TYPE:
740
ADDRESS:738 CHESHIRE CT.TELEPHONE:
(209) 482-8943
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY: 6CENSUS: 4DATE:
07/06/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Gloria AndresTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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On July 6, 2026, Licensing Program Analysts (LPA) Melina Oropeza and Licensing Program Manager (LPM) Liza King arrived at this facility unannounced to conduct a Required 1 Year Annual Inspection Visit. LPA was met by staff, Gloria Andres. This LPA requested that the facility staff person contact the facility designated Administrator, Emma Villamil, to inform her that CCL was present at this time. The facility designated Administrator was unable to be present at this time. LPA explained the purpose of the visit to staff. Administrator certificate for the facility designated Administrator, Emma Villamil, was observed to be present with certificate number #700938740 with expiration date of 05/07/2026.Certificate is expired no pending application noted online.

The facility currently has 4 dementia clients and a plan of op to serve dementia. The facility has a fire clearance for 2 bedridden in room 5 and 6 only, however 4 of 4 residents are bedridden. Additionally, 2 residents are sharing a room which is not cleared for sheared occupancy. 3 of 4 are on hospice.

LPA and staff inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations. Facility is a 6 bed facility with a current census of 4. There is entry door is leading to the living room, kitchen with a hallway to the bedrooms and bathrooms. Chemicals noted not to be locked and accessible, however at this time residents don't have access given their bedridden status. Medication cabinet located in the front entry closet was observed to be locked and made inaccessible to the residents at this time. Two staff rooms. There are no MARS.

cont 809-c.

NAME OF LICENSING PROGRAM MANAGER: Liza King
NAME OF LICENSING PROGRAM ANALYST: Melina Oropeza
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 HOME FOR SENIORS II
FACILITY NUMBER: 392701301
VISIT DATE: 07/06/2026
NARRATIVE
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The facility is under construction and renovating the bathrooms, CCL was not notified and has requested the permit to be emailed with the POC. Garage area was toured. It was observed that this area was used mainly to store facility related items at this time. No bodies of water were observed at the facility.

Hot water temperature was measured at 115 F degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees Fahrenheit. LPA observed the following posted on the facility wall: Facility license, sketch, See Something Say Something poster, Ombudsman poster, Theft and Loss Policy, Resident Bill of Rights, Rights of Resident/Family Councils. LPA observed the facility to have adequate food supply of 7 days non-perishables and 2 days perishables in place. A visual inspection of the refrigerator showed expired food and the freezer showed unlabeled frozen food.

Resident rooms were sanitary and had the required furniture and furnishings and able to meet the needs of the residents at this time.

LPA observed, fire extinguishers inspected on 07/14/2025 and current, smoke detector. No carbon monoxide detector was observed. There is central heating and air in the facility. The first aid kit was found in compliance.

LPA reviewed two (2) staff files. All staff is fingerprint cleared and associated to the facility. One staff does not have current First Aid or CPR certifications on file. There was no record of initial and continuing training as required. There was a person in the facility that is not associated and does not have fingerprint clearance.



LPA reviewed four (4) resident facility files, 2/4 did not have an updated 602, 4/4 no Needs and Services Plan/ Reappraisal. 3/3 no hospice care plan, 1/4 no signed admissions agreement.

The Plan of Operation in the facility needs to be updated. The administrator is to email copies of the LIC 308, LIC 500 and liability insurance to LPA Oropeza. Administrator will contact LPA Oropeza to discuss TSP.

The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Administrator to email copies of corrected deficiencies to LPA Oropeza at Melina.Oropeza@dss.ca.gov.

Exit Interview was conducted. Appeal Rights were printed and a copy of report was given to the facility representative at this time.

NAME OF LICENSING PROGRAM MANAGER: Liza King
NAME OF LICENSING PROGRAM ANALYST: Melina Oropeza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2026
LIC809 (FAS) - (06/04)
Page: 3 of 9
Document Has Been Signed on 07/06/2026 02:32 PM - It Cannot Be Edited


Created By: Melina Oropeza On 07/06/2026 at 12:20 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: DIAMOND CARE HOME FOR SENIORS II
FACILITY NUMBER: 392701301

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87202(a)(2)
Fire Clearance
(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: (2) Bedridden persons

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
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Based on observation and record review, the licensee did not comply with the section cited above in that 4/4 resident's are bedridden, current fire clearance only allows for 2 bedridden. Additionally, each room is cleared as private, however there is a shared room, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/07/2026
Plan of Correction
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3
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The administrator will submit a plan of correction with 24 hours, July 7, 2026 by 12:00 pm.
Type A
Section Cited
CCR
87355(k)
Criminal Record Clearance
(k) The licensee shall maintain documentation of criminal record clearances or criminal record exemptions of volunteers that require fingerprinting and non-client adults residing in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview with staff, the licensee did not comply with the section cited above in that there was a person in the facility that is not associated and does not have fingerprint clearance, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/07/2026
Plan of Correction
1
2
3
4
The administrator will have staff read, review, sign and provide a delcaration of understanding the regulation via e-mail by via e-mail by July 7, 2026 by 12:00pm.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Liza King
NAME OF LICENSING PROGRAM MANAGER:
Melina Oropeza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/06/2026 02:32 PM - It Cannot Be Edited


Created By: Melina Oropeza On 07/06/2026 at 12:20 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: DIAMOND CARE HOME FOR SENIORS II
FACILITY NUMBER: 392701301

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87411(c)(1)
Personnel Requirements - General
(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above in 1 staff whom was observed to be the sole careviver during the time of arrival at the facility did not have a current CPR/First Aid certificate which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/07/2026
Plan of Correction
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The administrator will have staff take an online CPR/first aide training and provide a copy of the certificate to LPA via e-mail by July 7, 2026 by 12:00pm.
Type A
Section Cited
HSC
1569.69(b)
Other Provisions
(b) Each employee who received training and passed the examination required in paragraph (5) of subdivision (a), and who continues to assist with the self-administration of medicines, shall also complete eight hours of in-service training on medication-related issues in each succeeding 12-month period.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on interview and record review, the licensee did not comply with the section cited above in that staff does not have yearly training requirements which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/13/2026
Plan of Correction
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2
3
4
The administrator will ensure that all staff take online medication training and submit copies of certificates to LPA by July 13, 2026 by 5:00pm
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Liza King
NAME OF LICENSING PROGRAM MANAGER:
Melina Oropeza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/06/2026 02:32 PM - It Cannot Be Edited


Created By: Melina Oropeza On 07/06/2026 at 12:20 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: DIAMOND CARE HOME FOR SENIORS II
FACILITY NUMBER: 392701301

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.626(a)(2)
Other Provisions
(a) All residential care facilities for the elderly shall meet the following training requirements, as described in Section 1569.625, for all direct care staff: (2) Eight hours of in-service training per year on the subject of serving residents with dementia. This training shall be developed in consultation with individuals or organizations with specific expertise in dementia care or by an outside source with expertise in dementia care. In formulating and providing this training, reference may be made to written materials and literature on dementia and the care and treatment of persons with dementia. This training requirement may be satisfied in one day or over a period of time. This training requirement may be provided at the facility or offsite and may include a combination of observation and practical application.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on interview and record review if 2 staff files, annual training is not being conducted. This poses an potential health and safety concern.
POC Due Date: 07/13/2026
Plan of Correction
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2
3
4
The Administrator will email copies of required training to LPA by July 13, 2026 by 5:00pm.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Liza King
NAME OF LICENSING PROGRAM MANAGER:
Melina Oropeza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2026


LIC809 (FAS) - (06/04)
Page: 6 of 9
Document Has Been Signed on 07/06/2026 02:32 PM - It Cannot Be Edited


Created By: Melina Oropeza On 07/06/2026 at 12:20 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: DIAMOND CARE HOME FOR SENIORS II
FACILITY NUMBER: 392701301

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87468(b)
Personal Rights of Residents
(b) At the time the admission agreement is signed, a resident and the resident's representative shall be personally advised of and given a copy of:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in that 1 resident does not have a signed admission agreement which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/13/2026
Plan of Correction
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2
3
4
The administrator will ensure that the residents admission agreement is signed and a copy of the signed agreement will be emailed to LPA by July 13, 2026 by 5:00 pm
Type B
Section Cited
CCR
87219(a)
Planned Activities
(a) Residents shall be encouraged to maintain and develop their quality of life through participation in a variety of planned activities. The activities made available shall include:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in that there are no activities being provided to residents which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/13/2026
Plan of Correction
1
2
3
4
The administrator will have staff read, review, sign and provide a delcaration of understanding the regulation via e-mail by July 13, 2026 by 5:00pm.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Liza King
NAME OF LICENSING PROGRAM MANAGER:
Melina Oropeza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/06/2026 02:32 PM - It Cannot Be Edited


Created By: Melina Oropeza On 07/06/2026 at 12:21 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: DIAMOND CARE HOME FOR SENIORS II
FACILITY NUMBER: 392701301

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87405(d)(2)
Knowledge of and ability to conform to the applicable laws, rules and regulations

This requirement is not met as evidenced by: administrators failed to maintain pre apprissals, hospice care plans, and updated polcies and procedure.
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 4 of 4 resident files did not contain the required resident records pursuant to 87405, 3 of 3 did not include a hospice care plan pursuant to 87633, and the administrator failed to meet the requirements of care of bedridden residents pursuant 87606, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/20/2026
Plan of Correction
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2
3
4
The administrator will complete a residents record audit within 14 days and ensure the above regulations are met and a POC visit will occur to verify.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Liza King
NAME OF LICENSING PROGRAM MANAGER:
Melina Oropeza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/06/2026 02:32 PM - It Cannot Be Edited


Created By: Melina Oropeza On 07/06/2026 at 12:37 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: DIAMOND CARE HOME FOR SENIORS II
FACILITY NUMBER: 392701301

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87208(a)
The liceness shall have and maintain a current definitive plan of operations for the facility...

This requirement is not met as evidenced by: a review of the Plan of operation does not reflect the current services being provided by the fality such as medications being recorded on MARS, narrative does include care of persons, bed ridden, nor is it signed or updated.
Deficient Practice Statement
1
2
3
4
Based on record review the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/03/2026
Plan of Correction
1
2
3
4
The administrator will provide the department with an updated Plan of Operation within 30 days.
Type B
Section Cited
HSC
1569.626(a)

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training.

This requirement is not met as evidenced by:
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above in that staff do not have required training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/13/2026
Plan of Correction
1
2
3
4
The administrator will ensure that all staff take online required training and submit copies of certificates to LPA by July 13, 2026 by 5:00pm
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Liza King
NAME OF LICENSING PROGRAM MANAGER:
Melina Oropeza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2026


LIC809 (FAS) - (06/04)
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