<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603701
Report Date: 02/20/2025
Date Signed: 02/20/2025 09:47:51 PM

Document Has Been Signed on 02/20/2025 09:47 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:DIAMOND BAR RCFEFACILITY NUMBER:
198603701
ADMINISTRATOR/
DIRECTOR:
ANDREW MENTEFACILITY TYPE:
740
ADDRESS:1652 MAPLE HILL ROADTELEPHONE:
(909) 861-7430
CITY:DIAMOND BARSTATE: CAZIP CODE:
91765
CAPACITY: 6CENSUS: 4DATE:
02/20/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:59 PM
MET WITH:Taren Mente, StaffTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection. LPA met with Staff, Taren Mente, and explained the purpose of the visit. The fire clearance has been approved for a capacity of 6 residents, which 5 may be non-ambulatory and 1 bedridden. Bedroom #6 is approved for bedridden. The hospice waiver is approved for 4 residents.

LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tools.
Infection Control: Facility is continuing to follow their Infection Control plan. Staff are wearing gloves to assist residents.
Operational Requirements: The facility has a dementia care plan to accept or retain residents with dementia. There are currently 4 residents residing at the facility.
Structure/Physical Plant:
The facility is a single story home with 6 private resident bedrooms, 1 staff room, 4 bathrooms (2 communal bathroom, 1 in bedroom #4, and 1 jack and jill bathroom), living room, dining room, kitchen, and attached garage. The facility has a swimming pool in the backyard and is surrounded by a locked gate. Bathrooms have non-skid mats in the shower area and grab bars. Knives, cleaning solutions, and disinfectants are locked. The hot water temperature was measured between the required range of 105-120 degrees F. The backyard has a table and chairs for residents to use. The facility has auditory devices at the exit doors and the resident room's sliding doors.
Food Service: Sufficient food supplies of 2 day perishable and at least a week of non-perishable are observed. The kitchen is kept clean and sanitary. The refrigerator is maintained at 40 degrees F or below and the freezer at 0 degrees F or below.
Planned Activities: The facility has sufficient space to accommodate indoor and outdoor activities.

No deficiencies were observed today. LPA will return another day to complete the remainder of the domains. A copy of this report was given to Staff Taren.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1