197801934-10-21-2025-28-AS-NMAN-DMNR6D-20251021124433

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197801934
Report Date: 10/21/2025
Date Signed: 10/21/2025 12:44:44 PM

Document Has Been Signed on 10/21/2025 12:44 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:	COLE VOCATIONAL SERVICES COVINA 2		FACILITY NUMBER:	197801934
ADMINISTRATOR/ DIRECTOR:	MATT PORPORA		FACILITY TYPE:	775
ADDRESS:	515 S 2ND AVE		TELEPHONE:	(626) 915-6678
CITY:	COVINA	STATE: CA	ZIP CODE:	91723
CAPACITY: 45		CENSUS: 32	DATE:	10/21/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Angelita Fraijo - Program Director		TIME VISIT/ INSPECTION COMPLETED:	01:00 PM

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	Licensing Program Analysts (LPA) Nune Margaryan conducted an unannounced annual visit at the facility using the CARE tool. LPA met with Program Director Angelita Fraijo and explained the reason for the visit. The facility is licensed as an Adult Day Program to serve 45 developmentally disabled adults clients ages 18 and older. All clients in the day program receive services provided by San Gabriel / Pomona Regional Center. At the time of visit there were 32 clients at the facility. The day program is located in the suite of office building which include Lobby, kitchen, 3 bathrooms, Fitness room, Hobby room, Theater room, Changing room, Tech Lounge, Music room, Zen room, Director office, Assistant office and Storage room. There is an outdoor activity area. There is no pool or large body of water at the premises. LPA toured the facility, and the following were observed: The program site is clean, safe, sanitary and in good repair. All passageways are free from obstruction. 4 fire extinguishers observed at the facility and are fully charged. The bathrooms were observed to be clean and operational. The water temperature was tested in all 3 bathrooms and measured 109.01 - 116.02 degrees F, which is within the required range of 105 - 120 degrees F. There are storage cabinets / lockers for the clients and staff belongings. LPA observed disinfectant cleaner in the changing room cabinet unlocked and accessible to clients. Food is not prepared at this program and clients are able to bring their own food and staff would assist them to heat up the food during lunch time. The kitchen area has a refrigerator where the clients can store their food. The day program has adequate snacks for clients and there's a water dispenser from the refrigerator in the kitchen for client to use. Sharps are kept locked in Director office. Continue 809C

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025

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 10/21/2025 12:44 PM - It Cannot Be Edited

Created By: Nune Margaryan On 10/21/2025 at 12:13 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: COLE VOCATIONAL SERVICES COVINA 2	FACILITY NUMBER: 197801934
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

82087(a)(3)

Buildings and Grounds

(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (3) Disinfectants, cleaning solutions, poisons, and other items which 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
1 2 3 4	Based on observation, the licensee did not comply with the section cited above. LPA observed disinfectant cleaner in the changing room cabinet unlocked and accessible to clients, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/21/2025
	Plan of Correction
1 2 3 4	Disinfectant cleaner removed and locked immediately. Cleared at the time of visit.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 10/21/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025

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: COLE VOCATIONAL SERVICES COVINA 2	FACILITY NUMBER: 197801934
	VISIT DATE: 10/21/2025

NARRATIVE

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Facility does administer medication to one client and the medication is locked in the Assistant office. A first aid kit was observed in the facility with the required items and a first aid manual was available. Smoke/carbon monoxide detectors were observed to be fully operational. The last fire drill was conducted on 10/16/25. LPA reviewed 6 staff files. Staff had criminal background clearance and associated to the facility. Staff also has an updated First Aid and CPR certificates. LPA reviewed 5 Client files. Files are located in the Director office / Assistant office and stored in a locked cabinet. The client files consist of the admission agreement, IPP/Appraisal Needs & Services Plan, and medical assessment with the TB results.

During today’s inspection deficiency observed. See 809D for details.

An exit interview was conducted, and a copy of the report was provided along with appeal rights.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025

LIC809 (FAS) - (06/04)

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