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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200203
Report Date: 05/31/2023
Date Signed: 05/31/2023 03:17:31 PM

Document Has Been Signed on 05/31/2023 03:17 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: 51DATE:
05/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Michelle Bolivia, Program DirectorTIME COMPLETED:
02:45 PM
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On this day at around 10:00 am, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct an annual required inspection. LPA met with Michelle Bolivia, Program Director. LPA explained to Director purpose of the visit.

There were 6 clients with 2 staff observed in one of the rooms conducting activities. Director states that all the other clients are out in the community for their activities. Hot water measured at 108 F in 2 of 4 bathrooms. The program has a kitchen/dining area. However, day program does not provide meals to the clients. Clients bring their own food to the adult day program (ADP).There were multiple fire extinguishers observed that were full and last inspected on 3/22/2023. Carbon monoxide was tested and observed functional. Smoke detectors were last inspected on 8/17/2022. Last emergency drill was conducted on 4/28/2023. The program has a designated quiet room that is being used if a client is sick.

At around 1 am, LPA reviewed 4 staff and 4 client records. At around 1:15 pm, LPA interviewed 4 staff and 4 clients.

There are no deficiencies noted during the visit. Exit interview was conducted with Director and a copy of this report was given.
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.

LIC809 (FAS) - (06/04)
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