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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701123
Report Date: 02/22/2022
Date Signed: 02/22/2022 03:16:15 PM

Document Has Been Signed on 02/22/2022 03:16 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:DIAMOND OAK SENIOR CAREFACILITY NUMBER:
342701123
ADMINISTRATOR:ONWULI, OKAY J.FACILITY TYPE:
740
ADDRESS:8636 DIAMOND OAK WAYTELEPHONE:
(916) 690-8874
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 6CENSUS: 3DATE:
02/22/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Okay Onwuli TIME COMPLETED:
03:20 PM
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Licensing Program Analysts (LPAs) Avelina Martinez and Maja Jensen made an unannounced visit to this facility to conduct a pre-licensing inspection on 02/22/2022 at 1:15 PM. This is a follow up visit to the pre-licensing of 01/07/2022. The licensee did not pass the pre-licensing visit of 01/07/2022 and was asked to provide or address the following requests:

Sample of Employee and Resident binders


Covid-19 Mitigation Binder/(LIC 808)
Sample of Admission Agreement
Exterior Requests
Repair Missing Fence Board
Repair Hallway closet door and framing.
Remove Cob webs from laundry room.
Remove Debris from Backyard

LPAs met with Okay Onwuli and stated the purpose of today’s visit. Administrator holds current certificate # 6052179740 which expires 5/8/23, and there are 3 residents residing at this facility. LPA Martinez and LPA Jensen toured the facility with Okay Onwuli on 02/22/2022 at 2:00 pm. LPAs inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside yards of the facility to ensure compliance with Title 22 regulations. The facility was observed to be clean and in good repair with adequate lighting, furniture and ambient temperature for the comfort of the residents. Sample resident and staff binders were observed and in order. A COVID mitigation plan and an LIC 610E was observed. The grounds were clear of debris. The previously requested corrections were made to the inside and outside of the facility and photographed by LPA Maja Jensen.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: DIAMOND OAK SENIOR CARE
FACILITY NUMBER: 342701123
VISIT DATE: 02/22/2022
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A Component III Orientation presentation was conducted with Licensee. The applicant has passed the pre-licensing component of the application process. LPAs will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed.

An exit interview was conducted with Licensee and a copy of this report was given to the Licensee.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2022
LIC809 (FAS) - (06/04)
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