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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701123
Report Date: 07/27/2022
Date Signed: 07/27/2022 11:03:26 AM

Document Has Been Signed on 07/27/2022 11:03 AM - 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:
07/27/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:Chinyere OnwuliTIME COMPLETED:
11:15 AM
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On 7-27-22 at 10:01am, Licensing Program Analyst ( LPA) Michael Bilger arrived at this facility unannounced to conduct a post licensing visit.. LPA was greeted by Administrator Chinyere Onwuli and LPA explained the purpose of the visit.
LPA Bilger inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside backyard of the facility to ensure compliance with Title 22 regulations. Facility is a 6-bed residential care facility for the elderly with a current census of 4. LPA was screened upon entry for temperature and asked to sign in. COVID screening questions were asked prior to entry. Facility has 6 bedrooms and 3 bathrooms. One bedroom is for staff use. There is a formal living room and family/TV room for residents. All knives, toxins, and other chemicals were inaccessible to residents in care. "See something, Say something" poster was in place. Resident rights and rights of resident council notices posted. Emergency disaster plan and facility sketch updated and posted. Administrator certificate was posted and expires 5-8-23.
The facility has submitted a COVID mitigation plan. The facility has central entry point and has implemented screening and sign in procedures at the front door area. The facility conducts routine symptom screening for employees, residents, and visitors. LPA observed the facility to have hand washing, COVID - 19 informational, and social distancing signs posted throughout the facility, on the front door, and back yard. The facility has a designated infection control lead. The facility is able to designate and dedicated a Covid-19 room/bathroom if needed. Common touch surfaces are cleaned after each use. Refrigerator temperature measured at 40*F. Freezer temperature measured at 0*F. Three staff charts reviewed, and contained all required documents.
Water temperature reads between 105*F and 120*F in the bathroom and room temperature reads 75*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Facility has an emergency food and water kit. Fire extinguisher is fully charged and dated 7/5/22.
Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held and a report was given to Administrator Chinyere Onwuli
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
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.

LIC809 (FAS) - (06/04)
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