<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366403963
Report Date: 09/15/2023
Date Signed: 09/15/2023 10:45:35 AM

Document Has Been Signed on 09/15/2023 10:45 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:MERCYLAND HOMEFACILITY NUMBER:
366403963
ADMINISTRATOR:NOEL TUNDE ESHOFACILITY TYPE:
735
ADDRESS:6708 OSBUN ROADTELEPHONE:
(909) 386-5822
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY: 4CENSUS: 3DATE:
09/15/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:12 AM
MET WITH:NOel EshoTIME COMPLETED:
10:25 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On this day, Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to this facility in relation to complaint control number: 56-AS-20230822103713. LPA met with staff who phoned administrator Noel Esho. Administrator Esho arrived and was informed of the purpose of the visit.

During the investigation of the above mentioned complaint, it was discovered that day program clients who were found with bed bugs on their person and personal items reside at this home. Licensee provided proof of licensed pest control treatment and staff interviews confirm pest control visits to this home. During today's visit, LPA and Licensee inspected bedrooms and beds and observed absence of bed bugs.

No deficiency cited during today's visit. This report was discussed with an a copy was provided to Mr. Esho.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2023
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 1