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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200203
Report Date: 05/01/2024
Date Signed: 05/01/2024 02:44:27 PM

Document Has Been Signed on 05/01/2024 02:44 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/
DIRECTOR:		BOLIVIA, MICHELLEFACILITY TYPE:
775
ADDRESS:37400 CEDAR BLVD., SUITES A&BTELEPHONE:
(510) 797-1916
CITY:NEWARKSTATE: CAZIP CODE:
94560
CAPACITY: 90CENSUS: 59DATE:
05/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:MIchelle BoliviaTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On this day at around 10:15 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 Bolivia the purpose of the visit.

LPA inspected all the rooms in the program including but not limited to activity rooms, computer room, exercise room, kitchen/dining room, conference room and bathrooms. Hot water measured at 116.9 Fahrenheit and 117.3 Fahrenheit in bathrooms 1 and 2, respectively. The program has a kitchen/dining area. The day program does not provide meals to the clients. Clients bring their own food.There were multiple fire extinguishers observed that appeared full and were last inspected on 4/12/2024. Carbon monoxide in the kitchen was tested and observed functional. Last earthquake drill was conducted on 2/23/24 and last fire drill was conducted on 12/26/23 . The program has a designated quiet room that is being used if a client is sick or not feeling well. Two clients were observed in the computer room, one in the exercise room, one in the quiet room and multiple clients in the activity room. Bolivia states most of the clients are out in the community.

At around 11:15 am, LPA reviewed 5 staff and 5 client records. At around 1:10 pm , LPA interviewed 4 staff and 4 clients.

There are no deficiencies noted during the visit. Exit interview was conducted with Bolivia and a copy of this report was given.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
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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