Facility Evaluation Report, 09/08/2022 — Mercedes Diaz Homes, INC.

Licensing Program Analyst (LPA) Galarza made an announced visit and met with Administrator Claudia Lujan and Executive Director of Service Development Alicia Gonzalez to conduct a pre-Licensing evaluation.

An application was submitted to Community Care Licensing Department (CCLD) for an initial application of an Adult Residential Facility Community Placement Plan (CPP) home to serve adults ages 18-59 years, level 4n The requested capacity is for two (2) non -ambulatory clients and two (2) ambulatory developmentally disabled clients. Structure: Facility is a single-story home consisting of four (4) bedrooms, two (2) full non-ambulatory bathrooms, one (1) 1/2 restroom, kitchen, dining room, living room, laundry room, and a 2-car detached garage. The front yard has a grass lawn. The backyard has shaded patio area with furniture. Bedroom Clients: All bedrooms are private. Bedrooms are equipped with one bed, night-stand, chair, lamp, and overhead lightning. Bathrooms: Have a working toilet, wash basin, and bathtub. Linens & Hygiene Supplies: All beds had the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linens is stored in bedroom closets. Emergency Phone Numbers, Exit Plan: Emergency numbers are posted and readily available for review. One (1) fully charged fire extinguisher is in place. Facility has a land line telephone. Food Service: Dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery, and other sharp kitchen utensils were observed locked and inaccessible. Adequate food supply is stored in the kitchen and consists of the following: 2-day perishables, and 7-day non-perishables. Smoke Detectors: There are electrical & inter-connected smoke detectors located in all bedrooms, common areas, and hallways. Appliances: Refrigerator , oven, microwave, dishwasher and washer/dryer were observed.The residence is equipped with central heating and air conditioning. Toxins: Cleaning supplies, and toxins are locked only accessible to staff.