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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701086
Report Date: 03/24/2023
Date Signed: 03/24/2023 02:04:36 PM

Document Has Been Signed on 03/24/2023 02:04 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:DIAMOND OAK GUEST HOMEFACILITY NUMBER:
342701086
ADMINISTRATOR:MASSAQUOI, MOHAMEDFACILITY TYPE:
740
ADDRESS:8632 DIAMOND OAK WAYTELEPHONE:
(916) 685-4099
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 6CENSUS: 5DATE:
03/24/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
01:41 PM
MET WITH:Niomi MassaquoiTIME COMPLETED:
02:30 PM
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On 03/24/23 Licensing Program Analyst (LPA) Renee Campbell arrived at the facility at approximately 2:00 pm to conduct a post licensing visit. LPA Renee Campbell met with Niomi Massaquoi and explained the purpose of today's visit.

The grounds were observed to be well maintained and all paths were free of obstruction. The facility was observed to be sanitary and free of odor. There was adequate furniture throughout the home in the backyard for resident use. LPA Renee Campbell observed night lights in the hallway. The carbon monoxide detector and smoke detector was determined to be in good working order.

The facility was observed to maintain a 2 day supply of perishable food and 7 day supply of non-perishable food. There is an adequate linen supply on hand. All required signs were observed to be posted in prominent areas for easy viewing by residents and visitors.

The facility was determined to be in substantial compliance. An exit interview was conducted and a copy of this report was given to Licensee.
SUPERVISORS NAME: Emerita Curiel
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2023
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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