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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804100
Report Date: 01/27/2024
Date Signed: 01/27/2024 01:23:33 PM

Document Has Been Signed on 01/27/2024 01:23 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:DIAMOND CARE HOMEFACILITY NUMBER:
486804100
ADMINISTRATOR:ADONA, THELMAFACILITY TYPE:
735
ADDRESS:286 BEGONIA BLVDTELEPHONE:
(707) 718-4501
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 6CENSUS: 4DATE:
01/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Caregiver and AdministratorTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Cassie Yang arrived unannounced to conduct a required annual inspection. LPA met with caregiver, Sandra Martinez, and explained the purpose of the visit. Caregiver contacted Administrator, Thelma Adona, who arrived shortly afterwards.

During today's inspection, LPA and Administrator conducted a tour of the interior and exterior of the facility to ensure the health and safety of clients in care. LPA observed the presence of four clients and three direct support professionals. LPA observed sharps, toxins and medications to be locked and secured. LPA observe month of January 2024 facility calendar to be displayed in the common area. LPA observed the facility to be at a comfortable temperature of 72* LPA observed the facility to have ample supply of personal protective equipment, linens, and personal care. LPA observed facility to have 2+ day of perishable and 7+ days of nonperishable food present in the facility. LPA observed facility to be in compliance with fire clearance and licensure.

LPA and Administrator discussed the backlog of Administrator Certificate unit. LPA observed Administrator Certificate to be expired but LPA observed Administrator listed on pending renewal list.

File review was conducted for C1, C2, S1 and S2.

LPA and Administrator completed the full care inspection tool together and found facility to be in compliance.

Exit interview conducted and a copy of the report was provided.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2024
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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