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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603618
Report Date: 10/17/2024
Date Signed: 10/17/2024 02:27:29 PM

Document Has Been Signed on 10/17/2024 02:27 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:MERCEDES DIAZ HOMES, INC. - EL MOLINOFACILITY NUMBER:
198603618
ADMINISTRATOR/
DIRECTOR:		LUJAN-ACOSTA, CLAUDIAFACILITY TYPE:
735
ADDRESS:1200 N. EL MOLINO AVE.TELEPHONE:
(562) 945-4576
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY: 4CENSUS: 1DATE:
10/17/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:42 PM
MET WITH:Monique Najera, Direct Staff PersonTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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LPA Vaid made a post licensing visit to the facility. Met with Direct Support Person II, Monique Najera and Jada Carrillo explained the reason for the visit and was allowed entry. Administrator Cecilia Loaisiga arrived shortly after. One(1) client has been placed at the facility since 10/07/24, vendorized by Lanterman regional office. Staff/client ratio is 2:1.

Clients bedroom is equipped with one bed, night-stand, lamp, and overhead lighting. Two (2) full bathroom equipped with working toilets, wash basins, bathtub/ walk-in shower, including grab bars, nonskid surfaces, water temperature recorded at 108.2-109.8, respectively. Knives, cutlery, and other sharp kitchen utensils were observed locked and inaccessible. Adequate food supply is stored in the kitchen and consists of the following: 2-day perishables, and 7-day non-perishables. Emergency food supply was observed. There are electrical smoke detectors located in all bedrooms, common areas, and hallways. Common areas observed for the ability to safely serve the needs of the residents. The food service is reviewed for appropriate quantity and proper storage. Other storage observed for linen, emergency lighting, tools, toxic cleansers, general storage, and medications. Medication records and system implementation also observed. Personal accommodations observed for safety, privacy, and comfort. LPA reviewed client medication and the medication administration records. Client observed and responsive to the staff directions.

No health and safety concerns observed during visit. No deficiencies were noted on today's visit.
Conducted exit interview and copy of this report was left for the Administrator.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2024
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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