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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881330
Report Date: 07/28/2022
Date Signed: 07/28/2022 03:10:07 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/21/2022 and conducted by Evaluator Chinwe Nwogene
COMPLAINT CONTROL NUMBER: 18-AS-20220721115216
FACILITY NAME:DIAMOND COTTAGEFACILITY NUMBER:
331881330
ADMINISTRATOR:BRAVO, ARNOLDFACILITY TYPE:
740
ADDRESS:30778 DROPSEED DRIVETELEPHONE:
(951) 926-2398
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 5DATE:
07/28/2022
UNANNOUNCEDTIME BEGAN:
09:26 AM
MET WITH:Arnold Bravo and Venus Bravo, Facility OperatorsTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Unlicensed care is being provided.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPAs), Chinwe Nwogene and Crystal Colvin, conducted an unannounced visit to the home to initiate the investigation into the above allegation. LPAs met with facility operators Arnold Bravo and Venus Bravo, and informed them of the purpose of the visit.
Regarding the allegation, “Unlicensed care being provided”, it was alleged there were residents in the home who required elements of care and supervision. LPAs initiated the investigation on the date 7/28/2022. LPAs Interviewed Facility operators and residents, residents’ files and records were reviewed, and copies of pertinent documents were obtained. Interviews and record review revealed the five (#5) residents receives assistance with their activities of daily living. It was reported all five (#5) residents receive assistance with toileting and assistance with dressing. In addition, it was reported all five (#5) residents are dependent on the facilty operators to prepare meals for them. LPAs observed Resident #2 (R2)being fed by operator in bed.
Therefore, based upon the investigation this allegation is substantiated. California Code of Regulations (Title 22, Division 6) are being cited on the attached LIC 9099D). An exit interview was conducted, and a copy of this report was reviewed and provided along with appeal rights to Venus Bravo.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022
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 18-AS-20220721115216
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: DIAMOND COTTAGE
FACILITY NUMBER: 331881330
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/12/2022
Section Cited
CCR
1569.10
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RCFE; License or permit; necessity; No person...within the state & no state or local public agency shall operate, establish, manage, conduct, or maintain a residential facility for elderly in this state without a current valid license or current valid special permit..
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Operator will obtain a license before POC due date 8/12/2022
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This requirement was not met, as evidenced by; Based on interview and record review. This poses an immediate Health and safty risk to resident in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2