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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920091
Report Date: 01/28/2025
Date Signed: 01/28/2025 02:15:26 PM

Document Has Been Signed on 01/28/2025 02:15 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 WOOD SENIOR CARE LLCFACILITY NUMBER:
315920091
ADMINISTRATOR/
DIRECTOR:
MALIUCOV, SERGIUFACILITY TYPE:
740
ADDRESS:1652 WOODHAVEN CIRTELEPHONE:
(916) 305-1081
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY: 6CENSUS: 5DATE:
01/28/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Administrator- Sergiu MaliucovTIME VISIT/
INSPECTION COMPLETED:
02:20 PM
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On 01/28/2025 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a required 1 year annual inspection. LPA met with Administrator Sergiu Maliucov and explained the purpose of the visit. Upon arrival two (2) residents were enjoying a musical performance.

LPA and Administrator conducted a tour of the interior and exterior of the facility. Areas toured include but not limited to six (6) resident bedrooms, three (3) full bathrooms, two (2) half bathrooms, laundry room, common areas and backyard. In areas toured no health, safety or personal rights violations were observed. Medications, toxins and knives are locked and are inaccessible to residents in care. Facility has a food supply of two (2) perishable and seven (7) day non-perishable. Fire extinguishers are maintained and ready for emergency use. First aid kit is maintained.

LPA reviewed five (5) resident files. Resident files contain signed admission agreements, physician's reports, appraisals, identification sheets, releases, and resident's rights. Medications are centrally stored, locked, and appear to be given per doctor order. LPA compared medications to those being given for two (2) residents and found no discrepancies. Facility is correctly using the Medication Administration Records (MAR). LPA reviewed two (2) staff files. A review of staff records indicates that all facility staff has received criminal record clearances and/or are associated to this facility. Staff records reviewed indicated current first aid certificates completed and training is complete.

Exit interview conducted a copy of the report was left at the facility.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE: DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2025
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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