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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200203
Report Date: 03/06/2025
Date Signed: 03/06/2025 11:16:49 AM

Document Has Been Signed on 03/06/2025 11:16 AM - 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: 55DATE:
03/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Michelle BoliviaTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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On this day at around 9:00 0 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 purpose of the visit.

LPA inspected the Adult Day Program (ADP) inside and out including but not limited to
different activity rooms, quiet room, computer room, music room and bathrooms and outside area.

There were 17 clients and 5 Direct Support Professionals (DSPs) observed in the day program. The rest of the clients and staff were out in the community for different activities. Hot water measured at 111.6 Fahrenheit in two bathrooms. The program has a kitchen/dining/washing area. ADP does not provide meals to the clients. Clients bring their own food. There were multiple fire extinguishers observed that were full and last inspected on 4/12/2024. Carbon monoxide in the kitchen and activity room were tested and observed functional. Smoke detectors were last inspected in May 15, 2024. Last fire drill was conducted on 11/6/2024 and last earthquake drill was completed on 2/13/2025. The program has a designated quiet room that is being used if a client is sick or not feeling well.

At around 9:25 am, LPA reviewed 5 staff and 5 client records. All staff are fingerprinted cleared and associated to the facility. Staff have current first aid and CPR training.

No deficiencies were noted during the visit.

The following records need to be submitted to CCL by March 10, 2025: Lic 500, Roster of Clients, Liability Insurance, Infection Control Plan, Emergency Disaster Plan, Registration/Insurance/Driver License.

Exit interview was conducted with Bolivia and a copy of this report was provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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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