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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200099
Report Date: 02/12/2025
Date Signed: 02/12/2025 01:21:04 PM

Document Has Been Signed on 02/12/2025 01:21 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:LADY OF MERCED CARE HOME, INC.FACILITY NUMBER:
019200099
ADMINISTRATOR/
DIRECTOR:		GERALDINE LARAFACILITY TYPE:
735
ADDRESS:26768 LAUDERDALE AVENUETELEPHONE:
(510) 785-8997
CITY:HAYWARDSTATE: CAZIP CODE:
94545
CAPACITY: 6CENSUS: 3DATE:
02/12/2025
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Geraldine Lara/Administrator
and Mercedita Lara/Licensee		TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On this day, 2/12/25, at 12:00 noon, Licensing Program Analyst (LPA) Delmundo conducted a Health and Safety check as a result of LPA receiving call on 2/07/25 from Geraldine Lara, administrator (ADM). ADM reported that the facility had fire incident in late afternoon on 2/06/25 which started in the kitchen. Staff (S1) was cooking at the time, went out to the backyard, and the frying pan started burning. ADM was at the facility at that time and took the frying pan out. Staff called 9-1-1 immediately. Fire fighters arrived but the fire was already extinguished. The fire fighters cleared the facility since only the bottom of the microwave get burned and residents returned to the facility that same day.

LPA was granted entry by staff, Praxedes Pascual. LPA checked and observed a new microwave has been installed. LPA called and spoke over the phone with ADM and informed the reason for visit. According to ADM, the new microwave was installed yesterday, 2/11/25, and the electrical wiring was checked by an electrician. ADM also stated that S1 was terminated on 2/08/25.

Mercedita Lara, licensee, and ADM arrived at 12:57 pm.

No deficiency cited.

Exit interview conducted and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE: DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2025
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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