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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602052
Report Date: 01/30/2026
Date Signed: 01/30/2026 07:14:59 PM

Document Has Been Signed on 01/30/2026 07:14 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:SOUTH BAY VOCATIONAL CENTERFACILITY NUMBER:
198602052
ADMINISTRATOR/
DIRECTOR:		COREY SYLVEFACILITY TYPE:
775
ADDRESS:21915 FIGUEROA STREETTELEPHONE:
(310) 901-4969
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY: 32CENSUS: 21DATE:
01/30/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Cristina Jimenez TIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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On January 30, 2026, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the Cares Tool. LPA met with the program manager Cristina Jimenez. LPA explained the purpose of today’s visit. The facility is licensed to operate for thirty-two (32) consumers of which four (4) may be non-ambulatory ages 18 through 59. The consumers are Harbor Regional Center, South Central Los Angeles Regional Center and Westside Regional Center.

The property is located in a commercial area of Carson. Jimenez stated that there are currently twenty (21) consumers enrolled. Jimenez stated no are currently no clients required prescribed medications or PRN assistance.

LPA along with the program manager toured the facility. The facility consists of (2) activity rooms, (1) kitchen, (1) men's restroom, (1) women's restroom, (1) handicap restroom, and (2) staff offices. LPA observed the facility is clean, sanitary, yet needs repair in bathroom three (3). The facility has smoke detectors that were tested and operable and (2) fire extinguishers were fully charged. Toxins and sharp objects were locked and inaccessible to the consumer's inside kitchen area.

The men's and women’s restrooms are clean and operable. The water temperature was tested and measured at 111.2 F. The kitchen is clean and a refrigerator is available for consumers' and staff use. Food items in the refrigerator and food storage are properly stored. The day program does not provide lunch, however snacks are available to consumers. A first aid kit is available. Walkways throughout the day program are clear of hazards and all exits are clear of debris. The facility had all the mandated posters posted throughout the day program. The program has an Emergency Disaster Preparedness Plan. The Fire & Earthquake drills were conducted in January 5, 2026.

(Evaluation Report continues LIC 809-C)
NAME OF LICENSING PROGRAM MANAGER: Janae Hammond
NAME OF LICENSING PROGRAM ANALYST: Ernand Dabuet
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
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 01/30/2026 07:15 PM - It Cannot Be Edited


Created By: Ernand Dabuet On 01/30/2026 at 11:08 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SOUTH BAY VOCATIONAL CENTER
FACILITY NUMBER: 198602052

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/30/2026

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
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Based on observation, the licensee did not comply with the section cited above; LPA identified two hazardous chemical sprays (bug spary & Goo Gone) place on the floor in the multi purpose room accessible to clients in care. This violation which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/31/2026
Plan of Correction
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Licensee will ensure to store in locked storage all hazardous, toxic, poinson chemicals. Proof of correction is due 01/3/126.
*Corrected during visit*
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.
Janae Hammond
NAME OF LICENSING PROGRAM MANAGER:
Ernand Dabuet
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2026


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 01/30/2026 07:15 PM - It Cannot Be Edited


Created By: Ernand Dabuet On 01/30/2026 at 11:09 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SOUTH BAY VOCATIONAL CENTER
FACILITY NUMBER: 198602052

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/30/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82065(f)
Personnel Requirements
(f) All personnel shall be given on-the-job training or shall have related experience providing knowledge of and skill in the following areas, as appropriate to the job assigned and as evidenced by safe and effective job performance.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review], the licensee did not comply with the section cited above. LPA identified staff #2 and staff #3 did not have the require training completed on file. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/13/2026
Plan of Correction
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Licensee will ensure that all personnel staff have the required training completed before having direct support access with clients. Proof of correction must be sent to ernand.dabuet@dss.ca.gov
Type B
Section Cited
CCR
82065(g)(1)
Personnel Requirements
(1) The good physical health of each employee and individual licensee shall be verified by a health screening, including negative test results for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above, LPA identified 4 out of the 5 staff did not have a health screen LIC 503 and TB test results. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/13/2026
Plan of Correction
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Licensee will ensure that all personnel staff have a health screen and TB test results. Proof of correction must be sent to ernand.dabuet@dss.ca.gov
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Janae Hammond
NAME OF LICENSING PROGRAM MANAGER:
Ernand Dabuet
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2026


LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: SOUTH BAY VOCATIONAL CENTER
FACILITY NUMBER: 198602052
VISIT DATE: 01/30/2026
NARRATIVE
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During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and consumers, sanitizing stations in common areas and restrooms.

During the visit, a review/audit of (5) client's and (5) staff files. The day program is current on annual licensing fees.

There are three(3) deficiencies cited during this inspection. (see LIC809-D)
  • At 10:50 AM, LPA identified a bug spray and toxic chemicals on the floor in the multi purpose room.
  • Staff #1, #2, #4 and #5 did not have a Health Screening LIC 503 and TB test results on file.
  • Staff #2 and Staff #3 did not have the required training verification.

Based on interviews, observation, and record reviews the licensee violated the California Code Regulations (CCR) of Title 22, Division 6, Chapter 3,

Deficiencies are issued and an exit interview is conducted with Cristina Jimenez. Appeal rights and a copy of the report was provided.
NAME OF LICENSING PROGRAM MANAGER: Janae Hammond
NAME OF LICENSING PROGRAM ANALYST: Ernand Dabuet
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026
LIC809 (FAS) - (06/04)
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