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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200983
Report Date: 02/21/2024
Date Signed: 02/21/2024 04:02:42 PM


Document Has Been Signed on 02/21/2024 04:02 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:M & M RESIDENTIAL CARE HOME INC.FACILITY NUMBER:
019200983
ADMINISTRATOR:MENDIOLA, MARIA CORAZONFACILITY TYPE:
735
ADDRESS:4835 JENNIFER CT.TELEPHONE:
(510) 952-9229
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:6CENSUS: 6DATE:
02/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Maria Corazon MendiolaTIME COMPLETED:
04:10 PM
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On this day at around 11:55 am, LPA Luisa Fontanilla arrived unannounced to conduct an annual required inspection. LPA met with the Administrator Maria Corazon Mendiola. LPA explained to the Administrator the purpose of the visit.

Facility has an approved Mitigation Plan. The facility has an approved fire clearance for 6 ambulatory clients. The facility is a Level 4G home vendorized by the Regional Center of the East Bay (RCEB)

LPA with the Administrator inspected the facility inside and out including but not limited to living room, dining area, kitchen, bedrooms, bathrooms, garage, front, side and backyard. Facility has sufficient perishable and non-perishable foods. Fire extinguisher was observed in the kitchen that appeared full and was last inspected on 10/19/2023. Facility has interconnected carbon monoxide and smoke detectors that were tested and observed functional. Hot water temperature in the kitchen was tested and measured at 108.6 degrees Fahrenheit. First aid kit was inspected and observed current and complete. Medications and chemicals were observed locked in different cabinets. Last fire drill was conducted on January 8, 2024.

At around 2:30 pm, LPA interviewed 2 staff and clients. At around 2:55 pm, LPA reviewed 5 staff and 5 residents files. P&I money and log were checked. Facility has sufficient surety bond to cover amount of money being handled at one time.

The following records were obtained during the visit: Emergency Disaster Plan, Lic 500, Roster of Clients, Liability Insurance, Surety Bond, Vehicle Registration/Insurance/Driver Licenses, Lic 400, Lic 308.

There is no deficiency noted for this visit. A copy of this report was provided to the Administrator.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Luisa FontanillaTELEPHONE: (510) 286-7147
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2024
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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