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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200203
Report Date: 05/02/2022
Date Signed: 05/02/2022 02:08:45 PM

Document Has Been Signed on 05/02/2022 02:08 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
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: 15DATE:
05/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Michelle Bolivia, Program DirectorTIME COMPLETED:
02:25 PM
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On 5/2/2022 at 1:00PM, Licensing Program Analysts (LPAs) G. Luk and G. Clark arrived unannounced to conduct an Infection Control Inspection. LPAs met with Program Director, Michelle Bolivia.

Upon entry, LPAs' temperature was checked and asked to fill out visitor's log. LPAs observed hand sanitizer at screening station. LPAs toured facility including but not limited to classroom, bathrooms, kitchen, and common areas. LPAs observed cough etiquette, signs & symptoms, and physical distancing are posted in the common areas. All hand washing stations were equipped with soap and paper towel. Hand washing posters were posted at bathrooms.

During record review, LPAs observed visitors log and temperature log for both clients and staff. LPAs observed facility has a copy of Mitigation Plan on file. LPAs observed PPE and paper supplies are sufficient.

No deficiencies are being cited on this date.

Exit interview conducted. A copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2022
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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