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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603739
Report Date: 02/11/2025
Date Signed: 02/11/2025 10:55:28 AM

Document Has Been Signed on 02/11/2025 10:55 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:MENTONE HOUSEFACILITY NUMBER:
197603739
ADMINISTRATOR/
DIRECTOR:
ROBIN PHILLIPSFACILITY TYPE:
735
ADDRESS:1980 MENTONETELEPHONE:
(626) 398-5629
CITY:PASADENASTATE: CAZIP CODE:
91103
CAPACITY: 6CENSUS: 10DATE:
02/11/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Administrator - Maggie EstradaTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced case management visit regarding a self-reported incident on the relocation of 5 clients from Harriet House, 24 W Harriet St Altadena Ca 91001 to Mentone House due to mandatory evacuation orders from Fire Advisory. LPA met with Administrator Maggie Estrada and explained the purpose of the visit.

During the visit, LPA conducted a health and safety check and no concerns observed. LPA reviewed and obtained copies of client and staff rosters for Mentone House, Administrator Maggie will email LPA copies of Staff/Client rosters from Harriet House. Facility maintains face sheets and MARs (Medication Administration Records) for all clients.

Per interview with Administrator, 5 clients have been temporarily relocated to Mentone House from Harriet House. The facility has sufficient beds, hygiene supplies, beddings, and linens. The dining room is large enough to accommodate all residents with staggered dining schedules. The kitchen has sufficient two-day perishable and seven-day non-perishable food supplies. Medications and MARs of the clients have been transferred to Mentone House and are stored in a secure location, LPA reviewed all 5 relocated clients medications with no issues observed.

There is sufficient staffing available to provide care for clients. It has been verified that a routine Fire inspection and testing was completed on 2/2/25 and a fire drill was conducted on 2/3/25 (drills at both facilities are conduced monthly, with proof of drills on file). Administrator confirmed all families, responsible parties and regional centers for the clients have been notified about the relocation either via calls, texts, or emails.

An exit interview was conducted and a copy of this report was provided to Administrator Maggie Estrada.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2025
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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