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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004210
Report Date: 07/16/2023
Date Signed: 07/16/2023 11:11:04 AM

Document Has Been Signed on 07/16/2023 11:11 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:MERCEDES DIAZ HOMES INC - TRUMBALFACILITY NUMBER:
306004210
ADMINISTRATOR:GRISELDA ELAIRFACILITY TYPE:
735
ADDRESS:13588 TRUMBALL STTELEPHONE:
(562) 941-5903
CITY:WHITTIERSTATE: CAZIP CODE:
90605
CAPACITY: 6CENSUS: 6DATE:
07/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:19 AM
MET WITH:Rosa Reynoso - AdministratorTIME COMPLETED:
11:25 AM
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced visit for an Annual Inspection. Upon arrival, LPA met with Ana Arredondo (Assistant Manager) and Rosa Reynoso (Administrator) who later assisted with the visit. The purpose of the visit was explained upon arrival. The facility is licensed to serve 4 non-ambulatory and 2 ambulatory developmentally disabled adult clients.

The facility is located in a residential area in Whittier, Ca. There are 4 bedrooms (2 individual rooms, 2 shared rooms), 2 bathrooms, living room, dining room, kitchen, back yard with shaded patio, and an attached garage with laundry room.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:
Infection Control: The facility staff are using appropriate hand hygiene while assisting clients’ medications. Staff are cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan.
Physical Plant & Environment Safety: There are 4 bedrooms, 2 bathrooms, kitchen, dining room, activity room, detached garage with laundry room and outside patio. All client bedrooms had the required furniture for comfort and safety and had sufficient lighting. All outdoor passages were free of obstruction. Bathrooms were clean, toilets and water faucets worked properly. Water temperature was measured throughout the client bathrooms and temperatures ranged from 108.9-115.1 degrees F which is within the required range of 105-120 Degrees F. Client bath towels, toiletries and personal hygiene supplies were adequately available. All storage areas for cleaning solutions, toxins, knives, and hazardous items are in locked cabinets within the attached garage. Smoke detectors and carbon monoxide detectors are operable and in compliance. There fire extinguishers were observed to be fully charged.
Operational Requirements: The facility has the appropriate fire clearance. The last Fire/Emergency Drill was conducted on 07/12/23. There is an outdoor activity area that is shaded and furnished for outdoor use.
(Continued on 809-C)
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE: DATE: 07/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/16/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: MERCEDES DIAZ HOMES INC - TRUMBAL
FACILITY NUMBER: 306004210
VISIT DATE: 07/16/2023
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Staffing: There appears to be sufficient staffing at all times in the facility. Administrator Mariano Prieto has a valid administrator certificate that expires on 08/12/24.
Personnel Records-Training: Staff has criminal record clearance. Staff have current CPR/first aid training and sufficient on-going training.
Client Rights-Information: The facility has Personal Rights Poster stationed the hallway. Facility provides internet and telephone access for the clients in care.
Client Records-Incident Reports: Client files are kept in a secured location and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan.
Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables.
Health Related Services: Medications for residents are securely stored in a locked cabinet. All medication observed during visit were properly labeled and in their original containers.
Incidental Medical & Dental: Staff designated to administer medication has the proper annual training on file.
Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites.
Emergency Intervention: Residents at this facility do not have restraints nor do they require the use de-escalation techniques.

LPA conducted 3 staff interviews and 2 client interviews during today’s visit.

Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies were observed during today’s visit.

Exit interview was held and a copy of the report was provided Administrator Rosa Reynoso.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2023
LIC809 (FAS) - (06/04)
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