306003911-5-9-2026-28-AS-FFIS-DUHLU4-20260528090316

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003911
Report Date: 05/09/2026
Date Signed: 05/09/2026 02:20:15 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/19/2026 and conducted by Evaluator Kimberly Ramirez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260219124633

FACILITY NAME:	MERCEDES DIAZ HOMES INC - CORNISHCREST 2		FACILITY NUMBER:	306003911
ADMINISTRATOR:	RUSSELL JOHNSRUD		FACILITY TYPE:	735
ADDRESS:	13617 CORNISHCREST RD		TELEPHONE:	(562) 946-3614
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90605
CAPACITY:	5	CENSUS: 5	DATE:	05/09/2026
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Maricela Gonzalez		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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Resident sustained unexplained injury due to staff neglect or abuse.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 05/09/2026 regarding the above allegation. During today’s visit LPA Ramirez was greeted by Maricela Gonzalez and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster, Staff Roster, Staff#1 - 5 interviews (S1 – S5), attempted interview of clients#1-5 (C1 – C5), copies of C1’s: Individual Program Plan (IPP), Physician’s Report, Vendor Special Incident Reports, hospital discharge reports, body check logs, and physical plant tour.

SEE 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260219124633

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 - CORNISHCREST 2	FACILITY NUMBER: 306003911
	VISIT DATE: 05/09/2026

NARRATIVE

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The investigation revealed the following: regarding the allegation “Resident sustained unexplained injury due to staff neglect or abuse.” It is alleged that C1 sustained an injury to their neck due to staff abuse or neglect. Five (5) out of the five (5) staff interviewed denied this allegation. LPA attempted interviews with C1 through C5. Due to documented intellectual disabilities, and because C1 through C5 are nonspeaking or use limited speech, their responses could not be relied upon. During record review of C1’s client files, LPA observed that C1 has a history of skin tears due to C1’s sensitive skin. LPA observed staffing notes and body check logs which indicated in January 2026 and February 2026, staff observed small skin tears on the left side of C1’s neck. Review of C1’s medical care record revealed C1 was treated for a common, benign and self-healing skin condition in older adults, which results in thinning of the skin. Staff sought treatment for C1 in both incidents and C1 was prescribed medication. Staff interviews revealed that C1 has very sensitive skin and C1’s skin will tear and bruise easily. Staff interviews revealed that even medical tape will cause C1 to get a skin tear. Staff interviews revealed that C1 normally rests their head to their left side, which causes skin friction and tears. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted. No deficiencies were cited for this complaint investigation. A copy of this report was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2026

LIC9099 (FAS) - (06/04)

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