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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004211
Report Date: 05/02/2024
Date Signed: 05/02/2024 05:05:09 PM

Document Has Been Signed on 05/02/2024 05:05 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 - CORNISHCREST 1FACILITY NUMBER:
306004211
ADMINISTRATOR/
DIRECTOR:		MARIANO PRIETOFACILITY TYPE:
735
ADDRESS:13742 CORNISHCREST RDTELEPHONE:
(562) 944-2372
CITY:WHITTIERSTATE: CAZIP CODE:
90605
CAPACITY: 6CENSUS: 5DATE:
05/02/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:Keily RamirezTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA) Angelica Rea conducted an unannounced visit in response to a Facility Unannounced Monitoring visit conducted by Eastern Los Angeles Regional Center (ELARC) on 4/8/24. LPA was greeted and allowed entry into the facility by House Supervisor, Keily Ramirez. Administrator, Mariano Prieto arrived at the facility a short time later and assisted with the visit.

LPA Rea obtained a copy of letter from ELARC dated 4/9/24, which indicated that the visit was for March 2024. LPA observed that the facility made some of the correction(s) that were needed at the time of the visit, and was given until 4/22/24, to make the other corrections.

During today's visit. LPA observed that all the corrections have been made. LPA did not observe any deficiencies during today's visit.

Exit interview was conducted, and a copy of report was provided to Administrator.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Angelica Rea
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2024
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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