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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004757
Report Date: 02/02/2024
Date Signed: 02/02/2024 11:45:04 AM

Document Has Been Signed on 02/02/2024 11:45 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:DIAMOND SENIOR CAREFACILITY NUMBER:
306004757
ADMINISTRATOR:ADELA ALBUFACILITY TYPE:
740
ADDRESS:13581 DIAMOND HEAD DRIVETELEPHONE:
(714) 508-3100
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY: 6CENSUS: 4DATE:
02/02/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Adela Albu, Administrator (via phone)TIME COMPLETED:
12:15 PM
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted an unannounced facility visit for the purpose of following up on an uncleared deficiency dating back to a type B citation issued on July 26, 2022 during the facility's annual inspection. LPA was greeted and granted entry by caregiving staff after introducing himself and stating the purpose of the visit. Administrator Adela Albu was notified of the visit via telephone and agreed to have caregivers sign on her behalf after being read the inspection report.

Several physician reports had been observed to be out of date during the 2022 annual, therefore they were out of compliance with the California Code of Regulations Section 87458(a).

During today's visit, LPA requested, obtained and reviewed resident records maintained at the facility for the four currently admitted residents. All physician reports on file were verified to be current. The deficiency was therefore cleared.

An exit interview was conducted and a copy of this report along with the clearance letter for the prior deficiency were provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2024
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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