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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200203
Report Date: 09/19/2024
Date Signed: 09/19/2024 01:41:51 PM

Document Has Been Signed on 09/19/2024 01:41 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: 65DATE:
09/19/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:10 AM
MET WITH:Michelle BoliviaTIME VISIT/
INSPECTION COMPLETED:
01:00 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
On this day at around 11:10 am, LPA Luisa Fontanilla arrived unannounced to conduct interview with Client 1 (C1). LPA informed the Program Director about the purpose of the visit. Upon LPA arrival at the day program, C1 was out in the community and came back at around 12:15 pm. .

During the visit, LPA interviewed C1 in connection with complaint #15-AS-20240917085416.

A copy of this report was provided to Bolivia.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1