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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603460
Report Date: 05/29/2026
Date Signed: 05/29/2026 12:27:29 PM

Document Has Been Signed on 05/29/2026 12:27 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ST. SHARBEL'S GARVEYFACILITY NUMBER:
198603460
ADMINISTRATOR/
DIRECTOR:		MUNZON, PETERFACILITY TYPE:
735
ADDRESS:2007 E GARVEY AVE NTELEPHONE:
(562) 682-7027
CITY:WEST COVINASTATE: CAZIP CODE:
91791
CAPACITY: 6CENSUS: 3DATE:
05/29/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:18 AM
MET WITH:Crispo Langa - DSP IITIME VISIT/
INSPECTION COMPLETED:
12:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA met with Crispo Langa, DSP II and explained the purpose of the visit. The administrator Peter Munzon was called on the phone and cannot come to the facility. The facility is licensed to care for (6) Developmentally Disabled Adults, ages 18 through 59, approved for (5) ambulatory and (1) non-ambulatory in master bedroom only. All clients residing at this facility receive case management services provided by San Gabriel Pomona Regional Center. LPA utilized the full Care Compliance and Regulatory Enforcement (CARE) Tools and observed the following:

Infection Control: The required cleaning and disinfection activities are performed. Infection control practices and Personal Protective Equipment (PPEs) were maintained. Staff are adhering to infection control


requirements and are trained in the proper use of all required PPE.
Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood, contains (4) client bedrooms, (1) office/staff room, (2 1/2) bathrooms, living room, kitchen, dining area and detached garage. Currently, there are (3) clients residing in the facility. The interior and exterior physical plant was inspected. Client bedrooms were toured and each bedroom has (2) beds with required beddings, furniture, sufficient lighting and closet space. Exit doors are free of any obstruction and there are no pools or large bodies of water. No security window bars installed. Facility has a working telephone service. Detached garage has a laundry area, additional non perishable food supplies and cleaning/laundry supplies in a locked cabinet. Kitchen knives, sharps objects, are kept locked in the kitchen drawer. LPA observed (1) fire extinguisher mounted on the dining area wall that has not been serviced since 3/31/2021. Facility is equipped with carbon monoxide alarm installed in the hallway and interconnected smoke detectors which were tested and operable. There are no firearms or weapons stored at the facility. Hot water temperature readings were within the required 105-120 degrees Fahrenheit.
Operational Requirements: Staff provide necessary personal assistance and care based on the clients'
needs and services plan. Surety bond insurance was verified and valid. The outdoor activity area has outdoor furniture and shaded area. *****CONTINUED ON LIC809-C*****
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2026
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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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: ST. SHARBEL'S GARVEY
FACILITY NUMBER: 198603460
VISIT DATE: 05/29/2026
NARRATIVE
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Staffing: Facility has sufficient staffing including the night staff to provide care and supervision to the clients. Staffing are maintained as specified by San Gabriel Pomona Regional Center. Staff employed are over the age of 18 and have criminal background clearance, and fingerprint cleared.
Personnel Records/Staff Training: Reviewed files for (5) staff members. Proof of staff training, health clearance, vaccinations and 1st Aid/CPR training are current. Administrator's certificate is valid and expires on 10/16/2026. Administrator has the required and valid HIV/AIDS training.
Client Records-Incident Reports: LPA reviewed all (3) client files. Client files are maintained at the facility. Admission agreement, Physician's Report (including TB and Ambulatory Status), Individual Program Plan/IPP, Needs and Services plan, Consent For Medical Treatment, Special Incident Reports, Client Personal Property and Clients Personal Rights observed. LPA observed that (2) out of (3) clients in care are over 59 years old and there was no exception request in order to retain the client.
Client Rights-Information: Client personal rights are posted. Facility provides internet services to all clients and have access to the facility phone.
Food Service: There are sufficient food supplies of 2-day perishable and 7-day non-perishable items. The food is properly stored in the refrigerator. There are zero (0) client with special or modified diets residing at this facility.
Health Related Services: LPA reviewed medication for all clients. The medications are centrally stored and in their original containers. The facility uses Medication Administration Record (MAR) and medications are administered as prescribed. None of the clients use oxygen. Administrator assists and arranges clients' medical and dental appointments.
Incidental Medical Services: There is (1) client with restricted health condition with care plan in the facility. There is no client with prohibited health condition.
Disaster Preparedness: Facility has emergency disaster plan and conducting quarterly drills. Emergency Disaster plan was last reviewed on 05/31/2024. Fire/Disaster drills are not conducted on a quarterly basis, last drill was on 01/14/2026.

Deficiencies cited and Technical assistance issued. Exit interview held telephonically with the administrator, Peter Munzon. A copy of this report along with the appeal rights were provided to Crispo Langa, DSP II.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/29/2026 12:27 PM - It Cannot Be Edited


Created By: Bennette Pena On 05/29/2026 at 12:05 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: ST. SHARBEL'S GARVEY
FACILITY NUMBER: 198603460

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
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 [(observation), the licensee did not comply with the section cited above in [3] out of [3] clients that (1) fire extinguisher mounted on the dining area wall should be replaced or serviced by a state licensed technician annually as the attached tag showed that it has not been serviced since 03/31/2021 which poses an immediate health, safety or personal rights risk to clients in care.
POC Due Date: 05/30/2026
Plan of Correction
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Administrator is to ensure that the fire extinguisher is fully charged at all times or serviced annually. Administrator agreed to purchase a new fire extinguisher and will send photo and purchase receipt to CCL/LPA by POC due date.
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.
Lisa Hicks
NAME OF LICENSING PROGRAM MANAGER:
Bennette Pena
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/29/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/29/2026 12:27 PM - It Cannot Be Edited


Created By: Bennette Pena On 05/29/2026 at 12:10 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: ST. SHARBEL'S GARVEY
FACILITY NUMBER: 198603460

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85068.4(g)
85068.4 Acceptance and Retention Limitations
(g) If acceptance or retention of an individual 60 years of age or older would result in the number of persons 60 years of age or older exceeding 50 percent of the census in facilities with a capacity of six or fewer clients, or 25 percent of the census in facilities with a capacity over six, the licensee must request an exception in order to accept or retain the individual. The exception request must be made in accordance with Section 80024. The documentation specified in Section 85068.4(c) must be submitted with the exception request.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee/administrator did not comply with the section cited above in which (2) out of (3) clients in care are over 60 years of age and there was no request for exception to retain the client which poses/posed a potential health, safety or personal rights risk to clients in care.
POC Due Date: 06/12/2026
Plan of Correction
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Administrator shall ensure that when accepting or retaining clients 60 years of age or older, the facility does not exceed 50 percent of the census. Administrator agreed to send an exception request letter along with other required documents for the client who is over 60 years of age currently residing in the facility to CCL/LPA by POC due date.

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.
Lisa Hicks
NAME OF LICENSING PROGRAM MANAGER:
Bennette Pena
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/29/2026


LIC809 (FAS) - (06/04)
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