<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200203
Report Date: 05/31/2023
Date Signed: 05/31/2023 03:18:14 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/02/2022 and conducted by Evaluator Luisa Fontanilla
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20220902144114
FACILITY NAME:SOCIAL VOCATIONAL SERVICES, NEWARKFACILITY NUMBER:
019200203
ADMINISTRATOR:KATHY D'AMARIOFACILITY TYPE:
775
ADDRESS:37400 CEDAR BLVD., SUITES A&BTELEPHONE:
(510) 797-1916
CITY:NEWARKSTATE: CAZIP CODE:
94560
CAPACITY:90CENSUS: 51DATE:
05/31/2023
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Michelle Bolivia, Program DirectorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not following proper COVID-19 mask guidance
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day, Licensing Program Analyst (LPA) Luisa Fontanilla arrived at the facility to conduct interview and deliver finding on the above allegation.

On 9/7/2022, then LPA Lizette Francisco initiated 10-day investigation and obtained records. On 3/17/2023, the complaint was reassigned to LPA Luisa Fontanilla. On 3/31/2023, LPA Fontanilla interviewed Program Director and reviewed records (email, doctor's orders).

Based on interview and record review, RP emailed Adult Day Program (ADP) on 9/19/2022 an unsigned doctor's note requesting Client 1 (C1) be exempted from wearing a mask while at the ADP. Director states she requested for a signed copy from RP due to the covid restrictions. On Saturday, October 1, 2022, Director received a signed doctor's note. On Tuesday, October 4, 2022, C1 came back to the program.

Based on interviews and record reviews, the above allegation is unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 15-AS-20220902144114
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: SOCIAL VOCATIONAL SERVICES, NEWARK
FACILITY NUMBER: 019200203
VISIT DATE: 05/31/2023
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
26
27
28
29
30
31
32
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

There is no deficiency noted.

Exit interview was conducted with Director and a copy of this report was provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2