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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600751
Report Date: 07/28/2026
Date Signed: 07/28/2026 11:59:19 AM

Document Has Been Signed on 07/28/2026 11:59 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CENTER FOR BEHAVIORAL CHANGE IFACILITY NUMBER:
198600751
ADMINISTRATOR/
DIRECTOR:		OLAYINKA KINGFACILITY TYPE:
735
ADDRESS:604 E MCKINLEY AVETELEPHONE:
(909) 865-2354
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY: 6CENSUS: 6DATE:
07/28/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Olayinka King, Administrator TIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA’s) Gabriela Castro conducted an unannounced required annual visit using the Compliance and Regulatory Enforcement (CARE) Tool. LPA was greeted by facility staff and explained the reason for the visit. Administrator Olayinka King arrived shortly thereafter.

The facility is approved for six (6) ambulatory clients only ages 18 to 59. All Clients residing at this facility receive case management services provided by San Gabriel Pomona Regional Center.

FACILITY TOUR AND OBSERVATIONS:

Personal Rights postings were observed in a common area. Residents had access to personal space, privacy, and adequate storage. No firearms/weapons were present.

Physical Plant

The facility is a one-story residential home consisting of three (3) client bedrooms, a kitchen, dining room, living room, two (2) bathrooms (one of which is private), an attached garage with a washer and dryer, a detached backyard garage with an additional freezer, and a covered backyard patio. All three client bedrooms were furnished with the required items, including a bed with a clean mattress, linens, a dresser, a chair, and adequate lighting. The bedroom with the private restroom had a cracked window. A deficiency will be cited for the cracked window, as it requires repair to ensure the facility remains safe and in good repair. .Extra clean linens and towels were stored in hallway cabinets, and all bedroom furniture was observed to be in good condition. During the inspection, LPA observed missing knobs on kitchen drawers and noted that the kitchen cabinets required cleaning. Both bathrooms were equipped with toilets and showers. The hot water temperature measured 120°F in Bathroom (1) and 118.8°F in Bathroom (2), which is within the required range of 105°F to 120°F. Smoke and carbon monoxide detectors were tested and found to be operational. A fully charged fire extinguisher was observed near the kitchen. All exits were free of obstructions, and no bodies of water were present on the premises. The backyard provided shaded seating for clients. The attached garage contained a locked storage area for chemicals and knives. (Continued on 809C)

David Sicairos
Gabriela Castro
DATE: 07/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2026
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CENTER FOR BEHAVIORAL CHANGE I
FACILITY NUMBER: 198600751
VISIT DATE: 07/28/2026
NARRATIVE
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 Food Service

Refrigerators/freezers were maintained at proper temperatures (refrigerators maximum of 40 degrees F and freezer 0-degree F) with sufficient supply of 2-day perishable and 7 days non-perishable food. An additional refrigerator in garage with fresh produce, proteins, and dry goods were stocked. Knives and cleaning supplies are locked in a locked cabinet in the garage and are inaccessible to clients.

Health-Related Services & Records:
Three (3) client files were reviewed and contained current required documents (Admissions Agreements, Pre-Placement Appraisals, Consents, Needs/Service Plans, Physician’s Reports with TB/ambulatory status, Rights acknowledgments, and IPPs). Medical/dental care was current. Three (3) medications were reviewed; medications are centrally stored in locked cabinet in the living room area, locked, and labeled. MAR logs were current. P&I funds were reviewed.

Disaster Preparedness:
Last fire/earthquake drill was conducted on May 4, 2026 is available. LIC 610D Emergency Disaster Plan was obtained and copy was collected for facility file. Emergency supplies (water, food, flashlights, batteries, first aid) were observed.

Personnel Records & Training:
Four (4) staff files were reviewed and included criminal record clearances, CPR/First Aid, DSP training, and TB screenings. Administrator Certificate for Olayinka King was valid through September 24, 2026. Staffing ratio met requirements.

Surety Bond & Insurance:
Liability insurance was in compliance with an expiration August 15, 2026.

An exit interview was conducted with Olayinka King Administrator During the inspection, deficiencies were observed and cited on the attached LIC 809D/809C in accordance with Title 22, Division 6 regulations. A copy of this report, LIC 809D/809C, and appeal rights will be provided via email.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Gabriela Castro
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026
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 07/28/2026 11:59 AM - It Cannot Be Edited


Created By: Gabriela Castro On 07/28/2026 at 11:33 AM
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: CENTER FOR BEHAVIORAL CHANGE I
FACILITY NUMBER: 198600751

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations made during the facility walkthrough, LPA observed a cracked window in one of the client bedrooms, missing knobs on several kitchen drawers, and kitchen drawers and walls that required cleaning which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/17/2026
Plan of Correction
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The licensee shall submit the following to LPA by the POC due date:A photograph of the repaired or replaced bedroom window, along with a copy of the repair or replacement invoice.Photographs showing that the missing kitchen drawer knobs have been replaced.Photographs demonstrating that the kitchen drawers and walls have been cleaned and are being maintained in a clean and sanitary condition.
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.
David Sicairos
NAME OF LICENSING PROGRAM MANAGER:
Gabriela Castro
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2026


LIC809 (FAS) - (06/04)
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