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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191571059
Report Date: 07/08/2025
Date Signed: 07/08/2025 07:27:12 PM

Document Has Been Signed on 07/08/2025 07:27 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:		VIVIAN SISONFACILITY TYPE:
735
ADDRESS:360 SANTA MARIANA ST.TELEPHONE:
(626) 369-3398
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY: 26CENSUS: 26DATE:
07/08/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Vivian Sison, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:20 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, 24 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 06/14/25 (House #1) and 6/15/25 (House #2).
LPA and Administrator toured the facility which included a random sample of client rooms and bathrooms 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 bathrooms were observed to be clean, operational and have the required hygiene items. The water temperature was tested in a random selection of client bathrooms in each home. In 2 clients bathrooms ( Hose # 2), between Room #7 - Room #8 and Room 9 - Room #12 hot water was measured at 128.3 degree F and 129.8 degree F. 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.
Continue 809C
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 07/08/2025 07:27 PM - It Cannot Be Edited


Created By: Nune Margaryan On 07/08/2025 at 12:06 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: 07/08/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80087(g)
Building and Grounds
(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.

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 observed cleaning supplies and toxins (2 Comet - bleach powder, Clorox Multi-Surface Cleaner+Bleach spray, Raid Ant & Roach spray, Grill and Fry Cleaner) are unlocked under the kitchen sink and accessible to the clients, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/08/2025
Plan of Correction
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Cleaning supplies and toxins were locked immediately.
Cleared at the time of visit.
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 ( Hose # 2), between Room #7 - Room #8 and Room 91 - Room #12 hot water was measured at 128.3 degree F and 129.8 degree F,
which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/08/2025
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.
Cleared at the time of visit.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Wei Siew Ho
NAME OF LICENSING PROGRAM MANAGER:
Nune Margaryan
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2025


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: 07/08/2025
NARRATIVE
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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. Sharps are locked in a kitchen drawer and are inaccessible to clients. LPA observed cleaning supplies and toxins (2 Comet - bleach powder, Clorox Multi-Surface Cleaner+Bleach spray, Raid Ant & Roach spray, Grill and Fry Cleaner) are unlocked under the kitchen sink and accessible to the clients. Detergents were locked in the laundry rooms and are inaccessible to clients. First Aid Kits (2) 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.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
LIC809 (FAS) - (06/04)
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