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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610538
Report Date: 07/11/2024
Date Signed: 07/11/2024 02:51:44 PM

Document Has Been Signed on 07/11/2024 02:51 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:AFMC DIAMOND CARE, INCFACILITY NUMBER:
197610538
ADMINISTRATOR/
DIRECTOR:		FERNANDO, AVELINO GFACILITY TYPE:
740
ADDRESS:27215 BARADA AVENUETELEPHONE:
(661) 487-4912
CITY:SANTA CLARITASTATE: CAZIP CODE:
91350
CAPACITY: 6CENSUS: 0DATE:
07/11/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Avelino FernandoTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Abeye Duguma conducted an announced Pre-licensing visit at around 09:30 AM and met with administrator, Avelino Fernando. LPA conducted an entrance interview with the Administrator. At the time of this visit LPA observed two (02) staff working in the facility.

With the assistance of the Administrator, LPA conducted a facility tour of both the inside and outside. The facility was inspected for Fire Safety, Personal Accommodations and Services, Medication Procedures and Food Service. This is a single-story property. Fire Clearance is approved for six (06) ambulatory.

Facility has four (04) bedrooms and two (02) bathrooms for residents. Two (02) out of four (04) bedrooms are semiprivate rooms. Resident bathroom has properly installed grab bars and shower has non-skid mats. Hot water temperature measured at 118.2ºF during the visit. All residents’ bedrooms were adequately furnished. The linens were stored in the storage space located at the end of the hallway. Towels and washcloths will not be shared.

The common areas were appropriately furnished and had adequate furniture. The LPA observed entertainment equipment and games for activities. The staff records were stored in a file cabinet located in the hallway. The first-aid kit is complete. The facility has adequate linen, water, perishable and nonperishable food supplies. The linens were stored in the storage space located in the hallway closet. LPA observed a fireplace with screen.

LPA inspected the kitchen and observed the stove and refrigerator to be clean and working. Facility had sufficient quantity and variety of perishable and nonperishable food supply. Nonperishable food was stored in the kitchen cabinets near the sink. Sharps are stored in a locked cabinet.

(CONT on LIC 809-C)

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2024
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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: AFMC DIAMOND CARE, INC
FACILITY NUMBER: 197610538
VISIT DATE: 07/11/2024
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The facility's smoke and carbon monoxide detectors were checked and observed to be functioning properly. There is a fully charged fire extinguishers located in the common area near the kitchen and observed to be purchased 12/10/2023. LPA advised the Administrator to retain the receipt of the fire extinguisher identifying the purchase date to ensure the time frame of annual inspection.

LPA Duguma observed a washer and dryer in the mud room adjacent to the garage. All chemicals, additional personal hygiene items were stored in the garage.

There is sufficient outdoor space with seating and a shaded area with proper furniture for outdoor use. There are no bodies of water on the premises.

At the time of this visit the physical plant is meeting Title 22 requirements.

Component III orientation was completed with the LPA during the visit.

No health and safety hazard were noted during this visit.

Exit interview was conducted and a copy of report was issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
LIC809 (FAS) - (06/04)
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