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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701301
Report Date: 08/14/2024
Date Signed: 08/20/2024 10:42:20 AM

Document Has Been Signed on 08/20/2024 10:42 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:DIAMOND CARE HOME FOR SENIORS IIFACILITY NUMBER:
392701301
ADMINISTRATOR/
DIRECTOR:
VILLAMIL, EMMAFACILITY TYPE:
740
ADDRESS:738 CHESHIRE CT.TELEPHONE:
(209) 482-8943
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY: 6CENSUS: 2DATE:
08/14/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Gloria AndresTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Unannounced Plan of Correction visit made out to this facility on 08/14/2024 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility staff person Gloria Andres. A brief interview was conducted with the facility staff person at this time. This LPA requested that the facility staff person go ahead and contact the facility designated Administrator, Emma Villamil, to inform her that CCL was present at this time.
Current census was 2 residents.
The purpose of this visit was to follow up on the deficiencies that were cited from a prior annual visit conducted on 07/10/2024. This visit was to follow up on the Plans of Correction that were due.
The following deficiencies were observed and cited on 07/10/2024:
  • For administrators this shall include verification that he/she meets the educational requirements in Section 87405(d) through (g).

  • Each resident's record shall contain at least the following information: Missing required forms and documents

  • Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (3) Obtain and evaluate a recent medical assessment.


This facility did complete the Plans of Correction and provided all of the required forms and documents at this time.
Plan of Correction clearance letters were printed and copies were provided to the facility staff person at this time.

There were no further deficiencies observed or cited during today's Plan of Correction visit. Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2024
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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