<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600273
Report Date: 10/16/2024
Date Signed: 10/16/2024 02:12:29 PM

Document Has Been Signed on 10/16/2024 02:12 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:MERCEDES DIAZ HOMES INC - MARWOODFACILITY NUMBER:
198600273
ADMINISTRATOR/
DIRECTOR:		JULIAN GARCIAFACILITY TYPE:
735
ADDRESS:4672 MARWOOD DRIVETELEPHONE:
(323) 254-6878
CITY:LOS ANGELESSTATE: CAZIP CODE:
90065
CAPACITY: 4CENSUS: 3DATE:
10/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:House Supervisor, Maria Guerra and Administrator, Rosa ReynosoTIME VISIT/
INSPECTION COMPLETED:
02:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted a Required One (1) year annual visit and inspection. LPA met with House Supervisor, Maria Guerra and Direct Support Professional (DSP), Angela Rosas who granted entry and explained the reason for the visit. Later Administrator arrived and joined us.

At 8:40a.m., House Supervisor and LPA conducted physical plant tour inside and outside. Required posting observed in facility in the entry area. This facility is retaining three (03) clients placed by Lanterman Regional Center. At the time of visit there was one (01) client at approximately 8:42a.m. client left to attend Day Program. Other clients were already at the day programs. The facility is fire cleared for two (02) ambulatory residents and two (2) non-ambulatory residents. During the visit the facility is at 75 degrees Fahrenheit. The smoke alarms are operational that are located each bedroom, the hallway and kitchen. There are carbon monoxide detectors that functions properly. The fire extinguisher is in the kitchen and garage with charge date of 01/29/2024. The facility is a single-story home and has three (03) client rooms and two (02) bathrooms in a residential community. Fire drill was last conducted on 10/02/2024. There are two (02) clients at the facility at the time of this visit.

Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough at least two (02) days perishable and seven (07) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked drawer in the kitchen. The menu was posted for review Adult Residential Facility (ARF), snacks and beverages are available for the clients in the facility when they want. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. Cleaning supplies, pesticides or toxic cleaning supplies were stored and locked away.

Continue to LIC 809-C
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: MERCEDES DIAZ HOMES INC - MARWOOD
FACILITY NUMBER: 198600273
VISIT DATE: 10/16/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Bedrooms: There were three (03) bedrooms designated for clients use. Room #1 and room #2 of the bedrooms are private, is used by clients were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Room #3 is shared room that is located at the end of the hallway. Bathrooms: There are two (02) bathroom designated for clients' use. The bathrooms were properly supplied and had functional fixtures. Hot water temperature measured at a range of 107.2°F to 107.6°F and within the required range. There was enough clean linen available in clients bedroom and cabinet located in the hallway. Client’s personal hygiene supplied are kept in baskets label with their name and picture in the hallway cabinet. Towels and washcloths are not shared. Common Areas: These included the living room and dining area for clients. The common areas were properly furnished. Dining table accommodates six (06) seats. LPA observed common areas to be very clean and tidy. LPA observed the floors to be in very good condition. No obstructions and or tripping hazards throughout the facility. Furniture in common area was observed to be in good repair. There are no issues with Fire Clearance. Surrounding Grounds: Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The facility does not have a swimming pool or body of water. The garage is storage for diapers, activity supplies, arts & craft materials, Personal Protective Equipment (PPE) and is used for parking. Laundry service: There is enough linen available to change weekly or more if need. Cleaning supplies are being stored in a locked cabinet and inaccessible to clients in the laundry area located in the garage. Staff Files: Staff records were reviewed, they all have criminal record clearances and associated to this facility. Staff have current first aid and training documentation showing training completed. Administrator's certificate was observed to be current. Office space is beside the garage behind the kitchen. Medications are in a centrally stored and locked place, including over-the-counter medicines; medications are properly labeled and checked for expiration dates. Each centrally stored prescription and PRN (As Needed) medication has been logged in the medications log with proper documentation from the clients’ doctor. Proper medication dispensing instruction are followed and checked for contamination. First-aid has all proper items and is current. Client records All three (03) client records were reviewed. Client records are complete and current at this time. LPA reviewed clients funds and observed receipts and funds balanced.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit. Exit interview conducted and a copy of the report issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2