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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700957
Report Date: 04/26/2023
Date Signed: 04/26/2023 03:55:10 PM

Document Has Been Signed on 04/26/2023 03:55 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME:SENIOR CARE @ DIAMOND OAKSFACILITY NUMBER:
342700957
ADMINISTRATOR:MACIUCA, ESTERAFACILITY TYPE:
740
ADDRESS:219 DIAMOND OAKS RD.TELEPHONE:
(916) 470-1416
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY: 6CENSUS: 5DATE:
04/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Estera MaciucaTIME COMPLETED:
04:00 PM
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On 4/26/25, LPA was present for an Annual inspection. While present, Licensee presented LPA with an incident report for R1 who had a fall on 4/22/23.

LPA and licensee discussed the fall of R1 and notifications made to necessary parties. R1 seems to receive needed care and supervision for identified care issues.

LPA observed and interviewed R1. R1 reports no pain or discomfort and stated they are happy with the care they receive.

As a result of this visit, no deficiencies are noted.
Report reviewed and copy provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2023
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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