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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306001354
Report Date: 12/22/2022
Date Signed: 12/22/2022 02:06:27 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
10/11/2022 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20221011140519
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: 5DATE:
12/22/2022
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Corazon LopezTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Facility has insufficient number of staff to provide care for the residents' needs
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation. LPA met with Administrator (AD) Corazon Lopez and explained the reason for today’s inspection. The investigation into the allegation that Facility has insufficient number of staff to provide care for the residents' needs revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, 1 witness, 5 residents, and 2 staff, reviewed Guardian records, and requested and reviewed Resident #1’s (R1) Physician’s Report dated 02/06/20 and undated Resident Appraisal.
It was reported that between August 2021 and July 2022, it was generally only AD providing care for the 6 residents as the main caregiver, although AD did a good job providing care and had help from 2 part-time staff, AD’s husband Staff #1 (S1), and AD’s child Staff #2 (S2). It was also reported that in the Summer of 2022, AD left the country for a month, so the main caregiver was not present at the facility. On 10/18/22, LPA inspected the facility and observed it to be clean and organized. LPA observed AD, S1, and S2 present, as well as 5 residents, and observed no health and safety issues.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
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-20221011140519
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: 12/22/2022
NARRATIVE
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LPA interviewed AD and S1 who stated that they are the facility’s only 2 care staff (apart from a weekly housekeeper), that they both live at the facility and provide care full time, all day every day, that they do not have any side businesses, and that they can provide all the care the residents need without difficulty because the residents do not need high levels of care. Regarding AD’s absence, AD and S1 stated that AD recently left the country for 3 weeks, but that S1 was able to handle everything while AD was gone without hiring additional staff. LPA interviewed 5 residents. 2 residents were unable to respond to questions. 3 residents interviewed stated they receive good care at the facility, that there are 2 staff (AD and S1) who provide care, that they have not received injuries at the facility, and that they have no problems at the facility and like living at the facility.
It was also reported that R1 developed a bruise and claimed that S2, who is underage and not qualified to provide care, had been providing care and pulled too hard which caused R1 to fall and develop the bruise. R1 has since passed away and could not be interviewed. When interviewed, AD and S1 stated that their child S2 is not a staff, is under 18 years old and goes to school, does not provide any care to the residents, but does help around the house by doing small tasks such as arranging tables and handing items like water to the residents. Regarding R1’s bruise, AD and S1 stated that R1 was weak, but would try to get up or walk, and would fall and that was the cause of the bruise. AD denied that S2 provided care to R1 or otherwise caused the bruise. LPA interviewed S2 who stated they do not provide care to any residents, they did sometimes move R1 around on a wheelchair, but denied causing or having any knowledge of R1 falling or being injured because most of their time is spent in school or studying. 3 residents interviewed corroborated that S2 does not provide care to residents. 1 resident knew R1 well and stated that R1 fell because R1 would try to walk but was physically unable to do so. Review of R1’s Physician’s Report dated 02/06/20 and undated Resident Appraisal corroborated that R1 had physical limitations due to a history of stroke and also revealed that R1 had Mild Cognitive Impairment, occasional confusion, and mild forgetfulness. While it is possible that S2 contributed to R2 having a fall, the observations made, interviews conducted, and records reviewed revealed no issues with the number and quality of the facility’s staff and their ability to provide care and supervision to the residents.
Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2