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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701123
Report Date: 05/03/2024
Date Signed: 05/03/2024 03:31:25 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/02/2024 and conducted by Evaluator Victoria Brown
COMPLAINT CONTROL NUMBER: 27-AS-20240502135542
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:
05/03/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Perlita LasapTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff mismanged resident's social security funds
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct an investigation of the above mentioned allegation on 5/3/24 at 1p. LPA met with Caregiver Perlita Lasap who contacted Administrator regarding todays visit. LPA reviewed Resident #1 (R1)'s file, and Interviewed CEPS representative during this visit. LPA received a copy of the email sent to Administrator stating the SSI Overpayment is required to be refunded as R1 was hospitalized on Janurary 31, 2024. LPA observed that a friend of R1 removed the belongings on 4/22/24 as R1 was relocated due to a need of higher level of care. Although the Licensee would be entitled to the bedhold monies until all belongings were removed, this complaint is in regards to overpayment of monies ($916.73) which were not due to the resident and it is due back to SSI through way of check to CEPS. The Title 22 regulations states under Admission Agreement (8) (A) General facility policies...All facility policies...shall not violate any applicable rights, laws or regulations.
Substantiated
Estimated Days of Completion: 30
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 27-AS-20240502135542
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: DIAMOND OAK SENIOR CARE
FACILITY NUMBER: 342701123
VISIT DATE: 05/03/2024
NARRATIVE
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Based on interview, confirmation the refund has not been received, and review of email sent to Administrator the allegation is deemed Substantiated.

The above allegation is SUBSTANTIATED. A finding that the complaint allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are cited on the 9099D during this visit.

Licensee was provided a copy of their rights (LIC9058) and their signature acknowledges receipt of these rights.

Exit interview held, a copy of report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20240502135542
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: DIAMOND OAK SENIOR CARE
FACILITY NUMBER: 342701123
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/10/2024
Section Cited
CCR
87507(8)(A)
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Admission Agreements
General facility policies...All facility policies...shall not violate any applicable rights, laws or regulations.
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Licensee shall send a check to CEPS for R1 in the amount requested by POC due date. Proof of payment shall be submitted to Community Care Licensing by POC date via fax.
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This requirement is not met as evidenced by: Based on confirmation that the Licensee has not refunded the overpayment amount of $916.73 to CEPS. This violation poses a potential health, and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3