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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701123
Report Date: 05/18/2022
Date Signed: 05/18/2022 04:11:11 PM

Document Has Been Signed on 05/18/2022 04:11 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: 4DATE:
05/18/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Administrator, Che Onwuli TIME COMPLETED:
04:25 PM
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On 05/18/22 at approximately 1:50 pm, Licensed Program Analysts (LPAs) T. White and R. Campbell arrived at this facility unannounced to conduct a case management visit regarding an incident report submitted to CCLD on 04/19/2022. LPAs met with the Caregiver, Liz Magpiong. LPAs later met with Administrator, Che Onwuli and explained the purpose of the visit.

Based on the incident report which occurred on 04/14/2022, R1 became agitated, caused damage to his room and made sexual advances towards both S1 and R2. Administrator contacted the hospital and was advised to return R1 back to the same hospital he had been discharged from.

Based on an interview with Administrator Che Onwuli, R1 came to the facility on the night of 04/13/2022. Kaiser had reported that if R1 exhibited negative behaviors, he should return back to the hospital. Administrator stated there was no completed admission agreement prior to accepting R1. Administrator stated R1 will not return to facility. Administrator stated appraisal visits will be conducted prior to residents admission into facility.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, no deficiencies nor Civil Penalties cited during this visit.



Exit interview held and signed. A copy of report was emailed to Administrator.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2022
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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