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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191571059
Report Date: 06/24/2024
Date Signed: 06/24/2024 03:32:05 PM

Document Has Been Signed on 06/24/2024 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:S.G. VALLEY TRAINING CENTER-RESIDENTIAL FACILITYFACILITY NUMBER:
191571059
ADMINISTRATOR/
DIRECTOR:		SUSAN HARMONFACILITY TYPE:
735
ADDRESS:360 SANTA MARIANA ST.TELEPHONE:
(626) 369-3398
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY: 26CENSUS: 24DATE:
06/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Vivian SisonTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Nune Margaryan conducted an annual required visit. LPA met with Administrator Vivian Sison and explained the reason for the visit. LPA used the infection control tool to evaluate the facility. The physical plant was inspected along with medications, food supply, and clients and staff records. The facility is licensed to serve mentally disabled adults ages 18-59. Currently, 22 clients receive services from San Gabriel/Pomona Regional Center and 2 clients receive services from East Los Angeles Regional Center. The facility is divided into two (2) single-story building units located in a residential area. Each building unit (House #1 & 2) contain: 1 unit for the live in staff, 1 staff bathroom, 1 kitchen, 26 client bedrooms (14 +12), 13 Jack & Jill style bathrooms (7+6), 5 walk in showers (3+2), dining room, living room, 3 laundry rooms (2 +1) and linen closets. Fire Drill were conducted on 06/23/2024 (House #1) and 05/22/2024 (House #2).
LPA and Administrator toured the facility which included a random sample of client rooms in House #1 and House #2. The patio areas are well maintained and there are no pools or large bodies of water. There is a shaded seating area for the clients located in the patio area of each home. Passageways and exits are free of obstruction. The water temperature was tested in a random selection of client bathrooms in each home. In 2 clients bathrooms, between Room #5 - Room #6 and Room #1 - Room #4 hot water was measured at 103.5 degree F and 102.7 degree F. The trash cans in the bathrooms were observed without lids. LPA also noticed that hand washing sinks in the clients bathroom Room #7 - Room #8, and Room #12 were not draining the water.
Client bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have sufficient closet space. Client beds have the required linen and the linen is in good condition. Smoke detectors were observed throughout the facility. There is a carbon monoxide detector in the kitchen of each home and were tested and operable during the visit. There are multiple fully charged fire extinguishers located throughout the facility. Kitchen appliances are clean and were operating at the time of the visit.
Continue 809C
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2024
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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Document Has Been Signed on 06/24/2024 03:32 PM - It Cannot Be Edited


Created By: Nune Margaryan On 06/24/2024 at 01:48 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: S.G. VALLEY TRAINING CENTER-RESIDENTIAL FACILITY
FACILITY NUMBER: 191571059

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. In 2 clients bathrooms, between Room #5 - Room #6 and Room #1 - Room #4 hot water was measured at 103.5 degree F and 102.7 degree F, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2024
Plan of Correction
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Water temperature was adjusted at the time of visit. The licensee will ensure that the hot water temperature is maintained between 105 degrees F - 120 degrees F as required.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Wei Siew Ho
LICENSING EVALUATOR NAME:Nune Margaryan
LICENSING EVALUATOR SIGNATURE:
DATE: 06/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2024


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 06/24/2024 03:32 PM - It Cannot Be Edited


Created By: Nune Margaryan On 06/24/2024 at 01:48 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: S.G. VALLEY TRAINING CENTER-RESIDENTIAL FACILITY
FACILITY NUMBER: 191571059

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80088(e)(3)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (3) All toilets, handwashing and bathing facilities shall be maintained in safe and sanitary operating condition. Additional equipment, aids, and/or conveniences shall be provided in facilities accommodating physically handicapped clients who need such items.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA noticed that hand washing sinks in the clients bathroom Room #7 - Room #8, and Room #12 were not draining the water, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2024
Plan of Correction
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Plumbing issues were fixed at the time of visit.
Type B
Section Cited
CCR
80088(f)(1)
Fixtures, Furniture, Equipment, and Supplies
(f) Solid waste shall be stored, located and disposed of in a manner that will not transmit communicable diseases or odors, create a nuisance, or provide a breeding place or food source for insects or rodents. (1) All containers, including movable bins, used for storage of solid wastes shall have tight-fitting covers kept on the containers; shall be in good repair, shall be leakproof and rodent-proof.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. The trash cans in the bathrooms were observed without lids, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/01/2024
Plan of Correction
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Licensee will purchase trash cans with covers and replaced them. Photo will be send to LPA by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Wei Siew Ho
LICENSING EVALUATOR NAME:Nune Margaryan
LICENSING EVALUATOR SIGNATURE:
DATE: 06/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2024


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: S.G. VALLEY TRAINING CENTER-RESIDENTIAL FACILITY
FACILITY NUMBER: 191571059
VISIT DATE: 06/24/2024
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Sharps are locked in a kitchen drawer and are inaccessible to clients. Cleaning supplies and toxins are locked under the kitchen sink and in the laundry rooms and are inaccessible to clients. First Aid Kits were fully stocked with current manuals. Sufficient supply of perishable for 2 days & non-perishable foods for 7 days were observed. LPA observed medications located in kitchen cabinet are locked and inaccessible to clients in care. Clients medications were reviewed at random. Medications are documented properly and given as prescribed.
LPA reviewed clients files to confirm emergency contacts have been updated. LPA confirmed staff working have fingerprint clearances.

Per California Code of Regulations, Title 22, the deficiencies observed are documented on the attached 809D.

Exit interview held. A copy of the report and appeal rights were provided to the Administrator.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024
LIC809 (FAS) - (06/04)
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