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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191502401
Report Date: 06/03/2024
Date Signed: 06/03/2024 04:26:09 PM

Document Has Been Signed on 06/03/2024 04:26 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/
DIRECTOR:		MARTA ESCANUELASFACILITY TYPE:
775
ADDRESS:525 AND 527 NORTH CHANDLERTELEPHONE:
(626) 289-8817
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91754
CAPACITY: 145CENSUS: 41DATE:
06/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:26 PM
MET WITH:Noey Garcia, Administrator TIME VISIT/
INSPECTION COMPLETED:
04:39 PM
NARRATIVE
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Licensing Program Analyst (LPA) Alberto Lopez conducted the unannounced annual inspection. LPA met with Administrator, Noey Garcia, and explained 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 7 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 was measured within the range of 101.1 – 131.2 degrees F which is not within the required range of 105.0 -120.0 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 09/2023
LPA reviewed 4 personnel files. The site coordinator and staff have the annual training hours and health screening forms along with TB test results but were not at the facility. They all have criminal background clearance and associated to the facility. LPA reviewed 4 Client files. The files consist of the admission agreement, IPP/Appraisal Needs & Services Plan, and medical assessment with the TB results. All IPP needs updating. There is one client who is taking routine medication during the program hours and it is documented when given. There are 5 clients that have PRN medications at the program but do not have PRN authorization letters. 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 but needs to be updated.

There are deficiencies issued today and technical advisories issued. An exit interview was held and a copy of this report was given to Noey Garcia along with appeal rights.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/03/2024
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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Document Has Been Signed on 06/03/2024 04:26 PM - It Cannot Be Edited


Created By: Alberto Lopez On 06/03/2024 at 03:51 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: MERCI SCHOOL
FACILITY NUMBER: 191502401

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. The hot water temperature ranged from 101.1 to 131.3 degrees F which is not within the range of 105.0 and 120.0 degrees F which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/04/2024
Plan of Correction
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Administrator will adjust water temperature and keep log for seven days and send to LPA at the conclusion of the seven days.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
SUPERVISOR'S NAME:Lisa Hicks
LICENSING EVALUATOR NAME:Alberto Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/03/2024


LIC809 (FAS) - (06/04)
Page: 2 of 8
Document Has Been Signed on 06/03/2024 04:26 PM - It Cannot Be Edited


Created By: Alberto Lopez On 06/03/2024 at 03:51 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: MERCI SCHOOL
FACILITY NUMBER: 191502401

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82075(b)(5)(A)
Health-Related Services
(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. (5) If the client's physician has stated in writing that the client is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, program staff designated by the licensee shall be permitted to assist the client with self-administration, providing all of the following requirements are met: (A) There is a written direction from a physician, on a prescription blank, specifying the name of the client, the name of the medication, instructions regarding a time or circumstance (if any) when it should be discontinued, and an indication of when the physician should be contacted for a medication reevaluation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. Five (5) clients have PRN medications at the program but the program does not have PRN authorization letters which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/10/2024
Plan of Correction
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Administrator will obtain PRN authorization letters for the five (5) clients and sent to LPA by POC date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Hicks
LICENSING EVALUATOR NAME:Alberto Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/03/2024


LIC809 (FAS) - (06/04)
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