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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191502401
Report Date: 06/20/2023
Date Signed: 06/20/2023 12:29:54 PM

Document Has Been Signed on 06/20/2023 12:29 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:MERCI SCHOOLFACILITY NUMBER:
191502401
ADMINISTRATOR:MARTA ESCANUELASFACILITY TYPE:
775
ADDRESS:525 AND 527 NORTH CHANDLERTELEPHONE:
(626) 289-8817
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91754
CAPACITY: 145CENSUS: 38DATE:
06/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Christina Salazar, Site CoordinatorTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection. LPA met with Site Coordinator, Christina Salazar, to explain the purpose of the visit. The day program is approved to serve 145 adults, of which 45 may be non-ambulatory.

LPA toured and inspected the facility using the CARE tools. The following were observed:

The day program consists of a main building with administrative offices and staff lounge and additional classrooms located to the rear. They are currently utilizing 6 classrooms to conduct activities with the participants. The middle building is being used as storage. There are communal bathrooms for clients to use in each building. The hot water temperature were measured within the range of 105 - 120 degrees F. There are no obstructions to the walkways and the facility is clean. Disinfectants and cleaning solutions are locked. The fire extinguishers were last inspected on 9/20/22.
LPA reviewed 3 personnel files. The site coordinator and staff have the annual training hours and health screening forms along with TB test results. They all have criminal background clearance and associated to the facility. LPA reviewed 3 Client files. The files consist of the admission agreement, IPP/Appraisal Needs & Services Plan, and medical assessment with the TB results. There is one client who is taking routine medication during the program hours and is documented when given. The medication is centrally stored and locked in the main office. The clients bring their own lunches and are not provided by the program.
The facility has the Emergency Disaster Plan with relocation sites, shutoff valves, and local emergency contact numbers.

There are no deficiencies issued today. An exit interview was held and a copy of this report was given to Christina Salazar.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2023
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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