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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603639
Report Date: 01/19/2024
Date Signed: 01/19/2024 12:15:34 PM

Document Has Been Signed on 01/19/2024 12:15 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:MERCEDES DIAZ HOMES, INC - VALEFACILITY NUMBER:
198603639
ADMINISTRATOR:COLLAR, NICOLEFACILITY TYPE:
735
ADDRESS:7751 VALE DR.TELEPHONE:
(562) 945-4576
CITY:WHITTIERSTATE: CAZIP CODE:
90602
CAPACITY: 4CENSUS: 4DATE:
01/19/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Steven Rodriguez, Assistant Administrator TIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Galarza arrived unannounced to conduct an Post Licensing inspection. LPA met with Assistant Administrator Steven Rodriguez and Quality Assurance Director Claudia Lujan who provided a tour of the entire facility.

The Facility is licensed for four (4) developmentally disabled adults ages 18-59. Currently there are four (4) residents residing at the facility. The facility is licensed as a level 4N home vendored by Eastern Los Angeles Regional Center. The inspection was completed using the CARE tools.



Observations:
  • LPA toured and inspected 4 resident rooms, 3 bathrooms, kitchen, 2-day perishable/7-day non-perishable food supply, medication storage area, activity areas, laundry area, garage, and outdoor areas were inspected. Sharps were observed secured in locked. The facility was free of odor, clean and in good repair. No obstructions were noted in hallways or living areas. Sufficient furniture and lighting was observed throughout the facility. There are no bodies of water.

  • Resident and staff file records were reviewed. Resident files contained required documentation including updated emergency information. A review of staff records indicates that all facility staff has received criminal record clearances and are associated to this facility. Staff records reviewed indicated the first aid certificates are current. The facility has conducted staff training as required.

  • Centrally stored medications were reviewed. They were observed locked and inaccessible to residents.

  • See Something Say Something complaint poster, Rights of Individuals with Developmental Disabilities, Evacuation Routes and facility license were all posted as required.

In the areas that were evaluated, no deficiencies were observed at the time of the visit.

This report was reviewed with Steven Rodriguez. A copy was provided at exit.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2024
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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