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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001354
Report Date: 06/16/2022
Date Signed: 06/16/2022 11:24:19 AM

Document Has Been Signed on 06/16/2022 11:24 AM - 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
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: 6DATE:
06/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Corazon Ann LopezTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Jessica Cho conducted an unannounced annual inspection focusing primarily on the Infection Control. LPA was greeted and granted entry by Administrator (Admin) Corazon Lopez. LPA stated the purpose of the visit and entered the facility at 9:40 am after completing the Coronavirus 2019 (COVID-19) screening procedure. There are no active COVID-19 cases as of today. Upon entry, LPA observed the screening station with hand sanitizer. Facility does not document temperatures, but a sign in sheet was created during the visit. The required COVID-19 precautionary signs were posted by the front entrance. The Administrator's Certificate for Corazon A. Lopez expires on 2/28/2023.

At 9:52 am, LPA and Admin toured the interior and exterior portions of the facility. The facility is a single level structure and licensed for six non-ambulatory; and has a hospice waiver for two residents. The facility had a total of six residents; two of which are in hospice care. LPA observed five residents watching television in the living room and one resident sleeping on the geriatric chair in the dining room. Facility appeared clean and sanitary in all observed areas. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxides tested operational. Restroom #1 out of two observed to be in good repair; and provided with a grab bar and a non-skid floor mat. Facility had the required hand washing sign posted in Restroom #1. Hot water measured at 105.8 degrees Fahrenheit in Restroom #1. LPA was unable to measure the water temperature in Restroom #2 located in the private bedroom of the Admin. Per Admin, residents utilize Restroom #2 with assistance when Restroom #1 is being used by another resident. LPA consulted that the Department has the inspection authority to access all rooms in the facility. However, Admin was resistant and upset, therefore LPA did not enter the private bedroom. Facility met the minimum two day perishable and seven day non-perishable food stock requirements. Medications, cleaning supplies, and sharp items were inaccessible to the residents in care. The fire extinguishers were mounted and charged in the kitchen.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2022
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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: DIAMOND MANOR
FACILITY NUMBER: 306001354
VISIT DATE: 06/16/2022
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For the exterior portion, the facility had patio furniture under ample shading, and grounds were free of tripping hazards. The side gates were self-closing and self-latching. LPA observed the emergency disaster and evacuation plans. Facility had sufficient emergency food and water supply. The First Aid Kit had all the required components, and the facility had sufficient PPE supplies.

LPA discussed Assembly Bill 665 that requires a licensee of any adult care residential facility that has internet service to provide at least one internet access device, such as a computer, smart phone, tablet or other device, that: can support real-time interactive applications; is equipped with video conferencing technology, including microphone and camera functions; and is dedicated for client or resident use. Facility provides a smart phone upon the resident's request.

LPA Cho reviewed the COVID 19 mitigation plan of the facility. No deficiency cited in this review as per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Administrator Corazon Lopez, and a copy of this report was provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC809 (FAS) - (06/04)
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