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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191571059
Report Date: 07/24/2023
Date Signed: 07/24/2023 03:32:26 PM

Document Has Been Signed on 07/24/2023 03:32 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:S.G. VALLEY TRAINING CENTER-RESIDENTIAL FACILITYFACILITY NUMBER:
191571059
ADMINISTRATOR:SUSAN HARMONFACILITY TYPE:
735
ADDRESS:360 SANTA MARIANA ST.TELEPHONE:
(626) 369-3398
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY: 26CENSUS: 24DATE:
07/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:26 AM
MET WITH:Susan Harmon TIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 07/22/2023 at 8:26 am. LPA was met by Administrator Susana Harmon and explained the purpose of the visit. The facility is licensed serve developmentally disabled clients 18-59 years old. Currently, twenty-two (22) clients receive services from San Gabriel/Pomona Regional Center and two (2) clients receive services from East Los Angeles Regional Center. LPA Ramirez requested and obtained copies of Resident Roster and observed Administrators Certificate for Susana M Harmon with an expiration date of 7/18/23.

LPA OBSERVATIONS: Tour began at 9:01 am and was led by Administrator Harmon. The facility is divided into two (2) single-story building units located in a residential area. Each building unit (Building #1 & 2) contain: two (2) staff bedrooms, one (1) staff bathroom, one (1) staff kitchen, twelve (12) client bedrooms, six (6) Jack & Jill style bathrooms, kitchen, dining room, living room, and linen closets.

Building #1: (Female only)

Front Yard: Was clean and well maintained. No hazards were observed.

Kitchen: LPA Ramirez observed refrigerator with chain link and pad lock. Facility has approved waiver dated 4/19/2005, that allows the facility to lock food storage area in facility kitchen. LPA Ramirez observed appliances to be clean and in working order. LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located kitchen cabinet, to be inaccessible to fourteen (14) out of fourteen (14) clients in care. Kitchen sink water temperature could not be tested due to staff performing maintenance on kitchen sink. Signs promoting hand washing were observed in this area.

Dining Room/Living room: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed plenty of seating and lighting. LPA Ramirez observed mini fridge in this area to be accessible and contain snacks and several beverages. LPA Ramirez observed fully charged fire extinguisher in dining room area.

Linen Closet: Contained plenty linens, towels, and hygiene products.

Client Rooms 1 - 12: LPA Ramirez selected random client bedrooms to inspect. Client bedrooms 5 & 6 were observed to contain the required linens, furnishings, and lighting. Client bedrooms 11 & 12 were observed to contain the required linens, furnishings and lighting.

SEE 809-C for continuation.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2023
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 3
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: S.G. VALLEY TRAINING CENTER-RESIDENTIAL FACILITY
FACILITY NUMBER: 191571059
VISIT DATE: 07/24/2023
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Client Shared Bathrooms: Client bathroom 5&6 was observed to be clean. LPA Ramirez observed signs promoting proper handwashing procedures. Water temperature in client bathroom# 5&6 was measured at 119.6 degrees F which is in the required 105 – 120 degrees F. Client bathroom #11&12 was observed to be clean and water temperature was measured at 117.7 degrees F which is in the required 105 – 120 degrees F.

Centrally Stored Medications: LPA observed cabinet located in kitchen cabinet to be locked and inaccessible to clients in care. LPA Ramirez reviewed two (2) client medications and did not find any discrepancies.

Backyard: LPA observed plenty of seating and shade. No large bodies of water were observed.

Emergency Drills (Conducted every 6 months): Proof of last documented fire drill was conducted 4/29/23 at 10:30 am & 4:30 pm.

Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher & Emergency Disaster Plan: LPA observed carbon monoxide and smoke detectors in hallways. Smoke detectors were observed to be operable and were last tested and serviced on 7/12/23. LPA Ramirez observed several fully charged fire extinguishers throughout the facility.

Staff Personnel Files: Staff files are maintained at facility. Five (5) staff files were reviewed. LPA Ramirez reviewed current First Aid/CPR certification, Health Screening and Tuberculosis Screening on file, Criminal record clearance, and initial training.

Client Files: Three (3) client files were reviewed. Admissions agreements, resident personal rights, and recent (2023) Individual Personal Plan (IPP) were observed in files.

Infection Control Plan: LPA Ramirez received a copy of Infection Control Plan last updated 5/2023.

Building #2: (Male only)

Front Yard: Was clean and well maintained. No hazards were observed.

Kitchen: LPA Ramirez observed appliances to be clean and in working order. LPA Ramirez observed refrigerator with chain link and pad lock. LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located kitchen cabinet, to be inaccessible to ten (10) out of ten (10) clients in care. Kitchen sink water temperature was measured at 112.2 degrees F. LPA Ramirez observed signs promoting hand washing and sneeze etiquette in this area.

Dining Room/Living room: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed plenty of seating and lighting. LPA Ramirez observed mini fridge in this area to be accessible and contain snacks and several beverages. LPA Ramirez observed fully charged fire extinguisher in dining room area. LPA Ramirez observed a flat screen TV and DVD player nearby.

SEE 809-C for continuation.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: S.G. VALLEY TRAINING CENTER-RESIDENTIAL FACILITY
FACILITY NUMBER: 191571059
VISIT DATE: 07/24/2023
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Linen Closet: Contained plenty linens, towels, and hygiene products.

Client Rooms 1 - 12: LPA Ramirez selected random client bedrooms to inspect. Client bedrooms 7 & 8 were observed to contain the required linens, furnishings, and lighting. Client bedrooms 10 & 11 were observed to contain the required linens, furnishings and lighting.

Client Shared Bathrooms: Client bathroom 7 & 8 was observed to be clean. LPA Ramirez observed signs promoting proper handwashing procedures. Water temperature in client bathroom# 7 & 8 was measured at 109.8 degrees F which is in the required 105 – 120 degrees F. Client bathroom #10 &11 was observed to be clean and water temperature was measured at 110.4 degrees F which is in the required 105 – 120 degrees F.

Centrally Stored Medications: LPA observed cabinet located in kitchen cabinet to be locked and inaccessible to clients in care.

Backyard: LPA observed plenty of seating and shade. No large bodies of water were observed.

Emergency Drills (Conducted every 6 months): Proof of last documented fire drill was conducted 6/25/23 at 5:15 pm.

Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher & Emergency Disaster Plan: LPA observed carbon monoxide and smoke detectors in hallways. Smoke detectors were observed to be operable and were last tested and serviced on 7/12/23. LPA Ramirez observed several fully charged fire extinguishers throughout the facility.

Client Files: Three (3) client files were reviewed. Admissions agreements, resident personal rights, and recent (2023) Individual Personal Plan (IPP) were observed in files.

No deficiencies are being cited. Exit interview was conducted Administrator Harmon and a copy of this report was provided.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023
LIC809 (FAS) - (06/04)
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