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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306001354
Report Date: 05/12/2021
Date Signed: 05/12/2021 03:05:40 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/28/2020 and conducted by Evaluator James August
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20200728144411
FACILITY NAME:DIAMOND MANORFACILITY NUMBER:
306001354
ADMINISTRATOR:LOPEZ, CORAZONFACILITY TYPE:
740
ADDRESS:15460 MARLBOROUGH CIRCLETELEPHONE:
(714) 486-2737
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY:6CENSUS: 4DATE:
05/12/2021
UNANNOUNCEDTIME BEGAN:
02:54 PM
MET WITH:Corazon Lopez, AdministratorTIME COMPLETED:
03:05 PM
ALLEGATION(S):
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Personal Rights
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) James August contacted the facility via telephone to deliver findings on a complaint investigation due to COVID-19 and pre-cautionary measures. LPA identified himself and discussed the purpose of the call and the elements of the allegation with Administrator Corazon Lopez.

The following are the findings of the investigation conducted by the Investigations Branch (IB) of Community Care Licensing Division, which involved interviews and records review.

On July 23, 2020, the Department received a complaint alleging that resident 1 (R1) was severely neglected by facility staff which resulted in the resident sustaining multiple unstageable pressure injuries. R1 was admitted to the facility on February 24, 2020. However, R1 had been receiving Home Health Services since December 26, 2019 by R1’s primary care physician (PCP). R1 developed a pressure injury on or about June 4, 2020. R1 received Home Health services and treatment on June 6, 2020. In addition, R1 received an assessment for services from West Coast Wound Care on June 11, 2020. Cont on LIC9099C....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: James August
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 22-AS-20200728144411
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: DIAMOND MANOR
FACILITY NUMBER: 306001354
VISIT DATE: 05/12/2021
NARRATIVE
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On October 6, 2020 R1’s PCP stated that he was aware of R1’s pressure injuries and was overseeing the treatment service provided by Home Health Services and West Coast Wound Care. R1’s PCP stated that he was not concerned with the care from the staff at Diamond Manor. R1’s PCP also indicated that R1’s medical illnesses associated to diabetes and peripheral vascular edema prolong R1’s healing. However, the wound slowly healed with no report of infection.

Due to R1’s health condition prior to residence at Diamond Manor and the ongoing services provided by Home Health Care for general and wound care services, in conjunction with services provided by West Coast Wound Care, there is not enough information to support the allegation of Neglect/Lack of Care and Supervision by the facility resulting in resident sustaining multiple pressure injuries.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted with Administrator Corazon Lopez and a copy of this report was provided via email. Administrator Lopez to sign the report and return to LPA August via email.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: James August
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2021
LIC9099 (FAS) - (06/04)
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