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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200481
Report Date: 08/25/2023
Date Signed: 08/25/2023 12:51:15 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/15/2023 and conducted by Evaluator Gregory Clark
COMPLAINT CONTROL NUMBER: 15-AS-20230615135247
FACILITY NAME:SVS OAKLAND ADULT DAY PROGRAMFACILITY NUMBER:
019200481
ADMINISTRATOR:RENE POCHEFACILITY TYPE:
775
ADDRESS:1830 EMBARCADERO SUITE 102TELEPHONE:
(510) 698-3990
CITY:OAKLANDSTATE: CAZIP CODE:
94606
CAPACITY:60CENSUS: 42DATE:
08/25/2023
UNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Rene Poche, Program DirectorTIME COMPLETED:
12:55 PM
ALLEGATION(S):
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Staff leaves clients unsupervised
INVESTIGATION FINDINGS:
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On 8/25/23 at 12:25 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver findings in regard to the allegations above. LPA met with Rene Poche, Program Director and explained the purpose of the visit.

During the course of investigation, LPA interviewed the reporting party (RP), the day program director (DPD) and R5. LPA also reviewed staff roster, client roster and outing schedules for June 2023.

Based on interviews conducted, client roster and outing schedules it was determined that R5 is in a group staffed by S1 and S2. Outing logs show this group had a full schedule of outings for the week of June 12 – 16, 2023. R5 reported that on June 13, 2023, she was picked up at her apartment in Alameda by S1. S2 and 2 other program participants were already in the van.

***report continues on LIC9099C***

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 15-AS-20230615135247
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: SVS OAKLAND ADULT DAY PROGRAM
FACILITY NUMBER: 019200481
VISIT DATE: 08/25/2023
NARRATIVE
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***report continues from LIC9099***

S1 then drove the group to a nail salon in Hayward. S1 exited the van and went into the nail salon. S2, R5 and the other 2 program participants stayed in the van. R5 stated that S2 stayed with the group in the van playing games on her phone and eating her lunch until S1 returned. S1 returned to the van and the group then went to nearby park to have lunch at 11 a.m.

This agency has investigated the complaint. We have found that the complaint was unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2