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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603624
Report Date: 03/13/2023
Date Signed: 03/15/2023 09:11:34 AM

Document Has Been Signed on 03/15/2023 09:11 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:INNOVATIVE REHABILITATION SERVICESFACILITY NUMBER:
198603624
ADMINISTRATOR:JOVEL, ADRIANAFACILITY TYPE:
775
ADDRESS:14101 E NELSON AVETELEPHONE:
(626) 934-2922
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY: 48CENSUS: 0DATE:
03/13/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Adriana Rodriguez JovelTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Alma Gonzalez conducted an announced pre-licensing inspection. Upon arrival, LPA met with Adriana Rodriguez Jovel (Administrator) who assisted with the visit.

An application was received on 10/17/2022, for Initial License #198603624 Adult Day Program.

During today's inspection, LPA observed the following:

Physical Plant: Administrator office, 8 additional offices, lobby, Conference room, work area, locker/ storage area, cleaning supply storage room, kitchen, 2 restrooms (Restroom #1 Women: 5 stall and 3 sinks, Restroom #2 - Men: 3 stalls, 2 urinals and 3 sinks, Quiet area room, class room, and a sitting area.

Operating hours: 8:00am to 4:30pm, Monday through Friday.
Fire safety clearance: Conducted and granted on 11/3/22.
Structure: Facility is clean and in good repair.
Emergency Phone Numbers & Exit Plan: Posted in through out the facility.
Smoke/Carbon Monoxide Detectors: Smoke / Carbon Monoxide detectors are centralized and were observed in the facility. Facility is also equipped with a centralized sprinkler system.
Appliances: Refrigerator and stove are available for clients' use.
Food Service: Day program does provide lunch for clients that chose to purchase lunch.
Transportation services: does not provide.
Drinking Water: Water dispensers available for client use.

(Continue to LIC809C)

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Alma Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2023
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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: INNOVATIVE REHABILITATION SERVICES
FACILITY NUMBER: 198603624
VISIT DATE: 03/13/2023
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Hot Water Temperature: measured at 112 degree (F) in the women's bathroom.
Toxins: Locked in the storage room.
Resident & Staff Files. Will be locked and stored in the facility office's where cabinets are located.
First-aid Kit: Contains the required supplies and located in the Quiet Room.
Reading Material, Games, Equipment and Other Activity Materials: Adequate supplies located in work area room.
Storage Area For Consumers. Lockers available for personal storage.
Fire Extinguishers: 7 fire extinguishers located in throughout the facility including work area, and kitchen.

Physical plant was cleared. Facility met the physical plant requirements as required per California Code of Regulations Title 22 Division 6.

Component III was also completed at the time of the visit and all required documents for Licensing were discussed.

A copy of this report will be shared with Central Applications Bureau (CAB).

If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.

Exit interview conducted and a copy of this report was provided to Administrator Adriana Rodriguez Jovel.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Alma Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023
LIC809 (FAS) - (06/04)
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