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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005490
Report Date: 03/12/2025
Date Signed: 03/12/2025 04:18:51 PM

Document Has Been Signed on 03/12/2025 04:18 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:MERCEDES DIAZ HOMES INC - GORDONFACILITY NUMBER:
306005490
ADMINISTRATOR/
DIRECTOR:		VENEGAS, BRENDAFACILITY TYPE:
735
ADDRESS:2620 GORDON AVETELEPHONE:
(562) 448-3387
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY: 4CENSUS: 4DATE:
03/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:37 PM
MET WITH:Brenda VenegasTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) William Vanegas made an unannounced inspection for the purposes of an annual inspection. Upon arrival LPA Vanegas was greeted and granted entry to the facility, LPA Vanegas explained the purpose of the inspection and set up equipment. LPA Vanegas conducted a tour of the facility and observed the following.

This is a one storied home with four bedrooms all of which are for clients in care. There is two bathrooms which are used for client use as well. There is an attached two car garage, and a large backyard big enough for clients to participate in outdoor activities upon client request. LPA Vanegas observed kitchen area to be clean and free of debris. LPA Vanegas observed a dishwasher, microwave, gas stove, refrigerator, washer, and dryer to all be in good condition and operational. LPA Vanegas observed a two day supply of perishable food, and a seven day supply of non-perishable food, and a sufficient amount of emergency water for all clients in care and staff on duty.

LPA Vanegas observed all client rooms to have required furnishings such as a chair, a bed, linens in good repair; meaning no strains or tears and enough storage space for personal belongings. Rooms are large enough to walk about freely, and no obstructions are blocking entry way.

LPA Vanegas observed client restrooms to be clean and free of any debris and mildew and for all restrooms to have all required furnishings such as grab bars, and slip resistant matts, water faucets and toilets tested operational. Water tested between 115.2 and 116.9 degrees.

LPA Vanegas observed all fire extinguishers to be up to date, and fully charged, LPA Vanegas observed all smoke detectors to be operational and in good repair.
CONTINUED ON LIC809C
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: MERCEDES DIAZ HOMES INC - GORDON
FACILITY NUMBER: 306005490
VISIT DATE: 03/12/2025
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LPA Vanegas observed all sharps, toxins, and medications to be locked away and inaccessible to clients in care. LPA Vanegas reviewed medications with AD Brenda Venegas, per LPA Vanegas review, all medications are being administered per physicians orders and documented accordingly.

LPA Vanegas reviewed P&I with AD Brenda Venegas. Per LPA Vanegas P&I is being documented correctly and all balances were accounted for. LPA Vanegas reviewed five staff files, and four client files. Per LPA Vanegas review, all files (Staff and Client) Contain all required documentation, staff training is up to date and documented correctly.

LPA Vanegas toured the outside of the facility and observed the following, there are no obstructions along the exit routes of the facility and side doors are self latching and unlocked. There is an outdoor shaded sitting area, and it is available for clients in care. LPA Vanegas observed facility first aid kit and it contained all required items such as adhesive tape, scissors, tweezers, bandages, a thermometer, and a first aid manual.

Based on observations made during today's inspection no deficiencies will be issued per title 22 chapter 8 division 6 of the California Code of Regulations. An exit interview was conducted with AD Brenda Venegas and a copy of this report was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC809 (FAS) - (06/04)
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