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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603624
Report Date: 03/10/2025
Date Signed: 03/10/2025 02:26:39 PM

Document Has Been Signed on 03/10/2025 02:26 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/
DIRECTOR:		JOVEL, ADRIANAFACILITY TYPE:
775
ADDRESS:14101 E NELSON AVETELEPHONE:
(626) 934-2922
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY: 48CENSUS: 41DATE:
03/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Nancy AcostaTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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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 Nancy Acosta ,Office Manager and explained the reason for the visit. Program Administrator Adriana Jovel arrived shortly after who assist with the visit. The facility is licensed as an Adult Day Program to serve 48 ambulatory adults clients. At the time of visit there were 41 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, sanitary and in good repair. All passageways are free from obstruction. Multiply fire extinguishers located in throughout the facility and are fully charged. LPA observed Disinfectants, cleaning solutions unlocked in the supply storage room and accessible to clients. The bathrooms were observed to be clean and operational. The water temperature was tested in the bathrooms. The hot water temperature measured 121.2 and 124.1 degrees F, which is not within the required range of 105 - 120 degrees F. 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 on 02/27/2025. LPA reviewed 5 client and 5 staff records. 1 out of 5 clients, IPP is older than one year. IPP dated 01/18/2023. Deficiencies were noted on LIC 809D per Title 22 regulations.
Exit interview was conducted with Program Administrator and a copy of this report, LIC 809D, and appeal rights were provided.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2025
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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Document Has Been Signed on 03/10/2025 02:26 PM - It Cannot Be Edited


Created By: Nune Margaryan On 03/10/2025 at 12:51 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: INNOVATIVE REHABILITATION SERVICES
FACILITY NUMBER: 198603624

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2025

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 observed LPA observed Disinfectants, cleaning solutions unlocked in the supply storage room and accessible to clients.unlocked in the supply storage room and accessible to clients, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/10/2025
Plan of Correction
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LPA observed Disinfectants, cleaning solutions locked immediately / inaccessible to clients. No further action needed.
Type A
Section Cited
CCR
82088(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 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. The water temperature was tested in the bathrooms and measured 121.2 and 124.1-degree F which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/10/2025
Plan of Correction
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Hot water temperature adjusted at the time of visit. No further action needed.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Wei Siew Ho
LICENSING EVALUATOR NAME:Nune Margaryan
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2025


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 03/10/2025 02:26 PM - It Cannot Be Edited


Created By: Nune Margaryan On 03/10/2025 at 12:51 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: INNOVATIVE REHABILITATION SERVICES
FACILITY NUMBER: 198603624

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82068.2(d)(1)
Needs and Services Plan
(d) If the client has an existing needs appraisal or individual program plan (IPP) completed by a placement agency, or a consultant for the placement agency, the Department may consider the plan to meet the requirements of this section provided that: (1) The needs appraisal or IPP is not more than one year old.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review , the licensee did not comply with the section cited above. 1 out of 5 clients, IPP is older than one year. IPP dated 01/18/2023.


which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/17/2025
Plan of Correction
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Program Administrator will obtain IPP for client #1 and will submit a copy to the department by POC due date 03/17/25.
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.
SUPERVISOR'S NAME:Wei Siew Ho
LICENSING EVALUATOR NAME:Nune Margaryan
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2025


LIC809 (FAS) - (06/04)
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