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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306001354
Report Date: 03/25/2024
Date Signed: 03/25/2024 11:21:29 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
01/03/2024 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240103133808
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:
03/25/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Corazon Lopez, AdministratorTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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9
Staff physically abused residents resulting in bruises.

The facility is not clean and well maintained resulting in insects in the facility.
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the allegations listed above. LPA was greeted and granted entry by staff after stating the purpose of the visit. Administrator Corazon Lopez was present at the facility and assisted with the visit.

An initial complaint investigation visit was held on January 4 after a complaint was filed on January 3, 2024. The complaint was investigated by the Department and consisted of two tours of the physical plant conducted with the facility’s administrator, a review of staff, resident and hospice records, a Health and Safety check conducted with no immediate health and safety issues observed with the residents, as well as additional interview with facility residents, witnesses, and facility staff.

CONTINUED ON FORM LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024
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 4
Control Number 22-AS-20240103133808
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: DIAMOND MANOR
FACILITY NUMBER: 306001354
VISIT DATE: 03/25/2024
NARRATIVE
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CONTINUED FROM FORM LIC9099
Resident R1 is an 88-year-old resident who was admitted at the facility on April 27, 2023, and discharged from it by their responsible party on December 18, 2023. R1 was then admitted to another undisclosed licensed facility. R1’s medical assessment indicates a primary diagnosis of Chronic Obstructive Pulmonary Disease and an indication of Mild Cognitive Impairment. R1 is described as displaying a high level of confusion and agitation during their admission at the facility. R1 was admitted to the facility with an admission onto hospice care present at the time and was discharged from hospice on or around December 8, 2023.

Regarding the allegation that Staff physically abused resident resulting in bruises, the following has been concluded: Interviews conducted with facility staff and multiple witnesses were unable to corroborate the statements reported by R1 to their family members that a staff member was responsible for acts of physical abuse on R1’s person, resulting in bruises. A fall incident was however evidenced by facility staff, witnesses, and hospice staff to have occurred during R1’s admission however it cannot be considered to have been abuse or neglect/lack of supervision from facility staff as the toileting care was stated to have been provided by hospice staff, as verified in the hospice visit notes provided during a follow-up visit.

Regarding the allegation that Facility is not clean and well maintained resulting in insects in the facility, the following has been concluded: Two distinct tours of the facility’s physical plant were conducted during unannounced visits on January 4 and March 21, 2024. Observation found the facility to be clean overall. No evidence of an insect infestation was found during either of the facility visits. Interviews conducted pointed to a previous instance of insects present at the facility which is being investigated as complaint reference #22-AS-20220721114113. The incident in question is stated to have occurred in 2022. None of the evidence gathered corroborates that the infestation alleged is still ongoing.

The two allegations listed above are therefore found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted, and a copy of this report was provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
01/03/2024 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240103133808

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:
03/25/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Corazon Lopez, AdministratorTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
Facility staff are not qualified to care for residents.
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the allegations listed above. LPA was greeted and granted entry by staff after stating the purpose of the visit. Administrator Corazon Lopez was present at the facility and assisted with the visit.

An initial complaint investigation visit was on January 4, 2024, after a complaint was filed on January 3, 2024. The complaint was investigated by the Department and consisted of two tours of the physical plant conducted with the facility’s administrator, a review of staff, resident and hospice records, a Health and Safety check conducted with no immediate health and safety issues observed with the residents, as well as additional interview with facility residents, witnesses, and facility staff.

CONTINUED ON FORM LIC9099-C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 22-AS-20240103133808
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: DIAMOND MANOR
FACILITY NUMBER: 306001354
VISIT DATE: 03/25/2024
NARRATIVE
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CONTINUED FROM FORM LIC9099-A
Resident R1 is an 88-year-old resident who was admitted at the facility on April 27, 2023, and discharged from it by their responsible party on December 18, 2023, with a primary diagnosis of Chronic Obstructive Pulmonary Disease and an indication of Mild Cognitive Impairment. R1 is described as displaying a high level of confusion and agitation during their admission at the facility. R1 was admitted to the facility with an admission onto hospice care present at the time and was discharged from hospice on or around December 8, 2023.

Regarding the allegation that Facility staff are not qualified to care for residents, the following has been concluded: Based on interviews conducted, facility observation and records reviewed, care and supervision at the facility is provided by the licensee and staff member S1, with very occasional relief shifts by a third staff member who has however not been scheduled to work in a long time prior to the first visit being conducted. This is corroborated by observations made during two separate unannounced facility visits. Interviews conducted also failed to corroborate that a minor residing on the premises was taking any active part in providing care and supervision to the residents in care.

Additionally, LPA reviewed training records for S1 and verified that the administrator certification held by the licensee was valid and up to date. The two individuals involved in providing care and supervision at the facility were therefore confirmed to have met the training requirements to work as administrator and/or caregiver at the facility.

The allegation is therefore found to be Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis.

This agency has investigated this complaint. No deficiencies cited.

An exit interview was conducted, and a copy of this report was provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4