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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920030
Report Date: 09/15/2023
Date Signed: 09/15/2023 05:22:45 PM

Document Has Been Signed on 09/15/2023 05:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:DIAMOND OAKS HOME CAREFACILITY NUMBER:
315920030
ADMINISTRATOR:GARCIA, RICHARDFACILITY TYPE:
740
ADDRESS:403 MURRAY CT.TELEPHONE:
(916) 346-7177
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY: 6CENSUS: 0DATE:
09/15/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Richard Garcia and Ty BalocaTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility announced on 9/15/23 to conduct a Pre-licensing referencing the infection control domain. LPA met with licensees explained the purpose of the visit.

LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed.


Component III topics were review.

Facility is in significant compliance.

License pending approval.

Exit interview conducted and copy of report left at the facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2023
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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