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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603624
Report Date: 02/27/2024
Date Signed: 02/27/2024 06:11:29 PM

Document Has Been Signed on 02/27/2024 06:11 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
CCLD Regional Office, 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: DATE:
02/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Adriana JovelTIME COMPLETED:
06:20 PM
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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced annual visit at the facility using the CARE tool. LPA met with Adriana Jovel and explained the reason for the visit. The facility is licensed as an Adult Day Program to serve 48 ambulatory adults clients. At the time of visit there were no clients at the facility.
The day program consists of Administrator office, 8 additional offices, lobby, Conference room, work area, storage area with the lockers for the clients, cleaning supply storage room, kitchen area, 2 bathrooms. (Bathroom 1 for Women and Bathroom 2 for Men) Quiet area room, classroom, and a sitting area. LPA toured the facility with Adriana Jovel and the following was observed: The program site is clean, safe, sanitary and in good repair. All passageways are free from obstruction. Disinfectants, cleaning solutions are inaccessible to clients and are locked in the supply storage room. Multiply fire extinguishers located in throughout the facility and are fully charged.
The bathrooms were observed to be clean and operational. The water temperature was tested in the bathrooms. There is no pool or large body of water at the premises. There is shaded area for the clients.
There are multiply First Aid kits at the facility. Each staff has one and kept in their office. All of them are fully stocked with all required items including a current manual. The ADP does not provide medication or meals to clients during ADP activities. Clients are able to bring their own food. Also, Day program does provide lunch for clients that chose to purchase lunch. There is a refrigerator where the clients can store their food. Smoke / Carbon Monoxide detectors are centralized and were observed in the facility. Facility is also equipped with a centralized sprinkler system. The last fire drill was completed today. LPA reviewed 3 client and 3 staff records.

An exit interview was conducted with Adriana Jovel and a copy of the report was provided.



SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2024
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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