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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601067
Report Date: 02/19/2026
Date Signed: 02/19/2026 04:58:58 PM

Document Has Been Signed on 02/19/2026 04:58 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:SYLVANWOOD RESIDENTIAL CARE HOMEFACILITY NUMBER:
198601067
ADMINISTRATOR/
DIRECTOR:		SHIELA ANA FABIANFACILITY TYPE:
735
ADDRESS:16428 SYLVANWOOD AVENUETELEPHONE:
(562) 860-6041
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 4CENSUS: 3DATE:
02/19/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:39 PM
MET WITH:Administrator- Shiela FabianTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elena Mallett conducted an unannounced Annual Inspection of the facility. LPA met with Staff in Charge and the purpose of the visit was explained. Administrator Shiela Fabian was contacted by phone and joined the visit shortly after.

The facility is located in a residential neighborhood in Norwalk. The facility consists of a living room, dining room, recreation area, kitchen, 4 private client bedrooms,1 staff room , 2 bathrooms, laundry room and a detached garage. There is a front and backyard area.

LPA completed the visit using Compliance and Regulatory Enforcement Tools (CARE) . The following domains were completed during the visit

Infection Control: Infection Control Plan was reviewed by LPA. Plan follows title 22 regulations. Staff is cleaning and wiping down high touch areas daily.

Physical Plant and Environmental Safety: Physical plant was clean with hallways and walkways free from debris and obstruction. The hot water temperature in one of the client restrooms measured below Title 22 regulations of 105F-120F. A deficiency was cited. See 809-D Grab bars and no slip bath tiles for the shower were observed in the restrooms . Smoke detectors and a CO2 detector were present and operational. Knives, Sharps and toxins and cleaners are locked and inaccessible to clients. The clients bedrooms contained all the required light and furnishings. One of the bedrooms listed for clients was being used as a staff room. A deficiency was cited. See 809- D.

Continued on 809-C

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Elena Mallett
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2026
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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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 02/19/2026 04:58 PM - It Cannot Be Edited


Created By: Elena Mallett On 02/19/2026 at 04:06 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: SYLVANWOOD RESIDENTIAL CARE HOME
FACILITY NUMBER: 198601067

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/19/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80010(a)
Limitations on Capacity and Ambulatory Status
(a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including the capacity limitation.

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 that one bedrooms ( bedroom #5) listed on the facility sketch for clients was being used as a staff bedroom which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/26/2026
Plan of Correction
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 By POC due date ,Administrator will email photo to LPA showing the room is no longer being used as a staff bedroom.
Type B
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(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 that the hot water in bathroom #2 measured at 70 degrees Farenheit which is below Title 22 requirments which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/26/2026
Plan of Correction
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By POC due date, Administrator will raise the water temperture and send a water log to office Fax for both client bathrooms that contains three readings a day for three consecutive days that are withing Title 22 requirements (105-120 degrees F)
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Fernando Fierros
NAME OF LICENSING PROGRAM MANAGER:
Elena Mallett
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/19/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/19/2026


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: SYLVANWOOD RESIDENTIAL CARE HOME
FACILITY NUMBER: 198601067
VISIT DATE: 02/19/2026
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 Extra linens and hygiene supplies were observed. The kitchen had operational appliances and was equipped to prepare and store food. The washer and dryer are in a laundry room and detergent is kept locked. The backyard patio was free of debris and obstruction and contained a shaded area with furniture for the clients to enjoy the outdoors. A fully charged fire extinguisher was present in the kitchen. The garage is used for storage only.

Operational Requirements: Fire clearance approval was observed. Plan of operation was observed. Outdoor activity space and supplies for clients' activities was observed. Facility handles 2 clients' PNI money and maintains a Surety Bond. 2 client PNI ledgers were observed with no issues. An activity calendar for clients was present.

Personal Records - Training: Locked storage space for staff files was observed. 5 staff files were reviewed with no issues observed. Administrator's certificate is current.

Client Records - Incident Reports: Locked Storage space for client files and medications was observed 3client files and 2 client medication files were reviewed. No issues were observed.

Client Rights - Information: All required postings were present.

Food Service: 2 day perishable and 7 day non perishable supply was present. Foods were kept separate from poisons and toxins. There was sufficient silverware, cups, plates and bowls for clients in care. A weekly menu was observed.

Health Related Services: First Aid Kit was observed along with a First Aid Manual.

Disaster Preparedness: Facility has an updated Disaster Plan. Facility has emergency food, water and several flashlights. A full first aid kit and first aid manual were available. A disaster drill is run monthly with all staff. The last drill was run on 01/01/26

Per Title 22 regulations there were deficiencies cited today. An exit interview was conducted with Administrator Shiela Fabian and copy of this Licensing Report along with Appeal Rights was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Elena Mallett
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2026
LIC809 (FAS) - (06/04)
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