198603624-2-12-2026-28-AS-NMAN-DR8VN6-20260212153436

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603624
Report Date: 02/12/2026
Date Signed: 02/12/2026 03:34:47 PM

Document Has Been Signed on 02/12/2026 03:34 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 SERVICES		FACILITY NUMBER:	198603624
ADMINISTRATOR/ DIRECTOR:	JOVEL, ADRIANA		FACILITY TYPE:	775
ADDRESS:	14101 E NELSON AVE		TELEPHONE:	(626) 934-2920
CITY:	LA PUENTE	STATE: CA	ZIP CODE:	91746
CAPACITY: 64		CENSUS: 47	DATE:	02/12/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:45 AM
MET WITH:	Nancy Acosta, Office Manager		TIME VISIT/ INSPECTION COMPLETED:	03:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	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 who assisted with the visit. LPA explained the reason for the visit. The facility is licensed as an Adult Day Program to serve 64 ambulatory adults clients. At the time of visit there were 47 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 Nancy Acosta 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 locked in the supply storage room and inaccessible to clients. The bathrooms were observed to be clean and operational. The water temperature was tested in the bathrooms. The hot water temperature measured 90.3 and 91.2 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 multiple First Aid kits at the facility and all of them are fully stocked with all required items. 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. There are storage cabinets/ lockers for the clients belongings.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/12/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026

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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Document Has Been Signed on 02/12/2026 03:34 PM - It Cannot Be Edited

Created By: Nune Margaryan On 02/12/2026 at 02:32 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: 02/12/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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
1 2 3 4	Based on observation, the licensee did not comply with the section cited above. The water temperature was tested in the bathrooms and measured 90.3 and 91.2 degree F which poses an immediate health, safety or personal rights risk to persons in care, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 02/12/2026
	Plan of Correction
1 2 3 4	The water temperature adjusted at the time of visit.

Type A

Section Cited

CCR

82020

Fire Clearance

All day programs shall secure through the licensing agency and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, record review, the licensee did not comply with the section cited above. Based on observation and record review, the licensee did not comply with the section cited above due to facility not having an approved fire clearance for non ambulatory clients. However 2 non ambulatory clients were observed present in the day program at the time of visit, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 02/13/2026
	Plan of Correction
1 2 3 4	Administrator/Licensee will submit the statement that they will not have non ambulatory clients by POC due date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Wei Siew Ho
NAME OF LICENSING PROGRAM MANAGER:

	Nune Margaryan
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/12/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026

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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: INNOVATIVE REHABILITATION SERVICES	FACILITY NUMBER: 198603624
	VISIT DATE: 02/12/2026

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Smoke / Carbon Monoxide detectors are centralized and were observed in the facility. Facility is also equipped with a centralized sprinkler system. LPA reviewed clients and staff records. At the time of tour of the facility LPA observed 2 non-ambulatory clients on the wheelchair in work area.

Deficiencies were noted on LIC 809D per Title 22 regulations. Immediate civil penalties were issued.
Exit interview was conducted with Office Manager and a copy of this report, LIC 809D, and appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/12/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026

LIC809 (FAS) - (06/04)

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