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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200675
Report Date: 03/03/2022
Date Signed: 03/03/2022 02:44:38 PM

Document Has Been Signed on 03/03/2022 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:SVS PLEASANTON ADULT DAY PROGRAMFACILITY NUMBER:
019200675
ADMINISTRATOR:PIER, RONFACILITY TYPE:
775
ADDRESS:6602 OWEN DRIVE SUITE 100TELEPHONE:
(925) 621-3902
CITY:PLEASANTONSTATE: CAZIP CODE:
94588
CAPACITY: 60CENSUS: 62DATE:
03/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Adrienne Phillips, Program DirectorTIME COMPLETED:
03:10 PM
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On 3/3/2022 Licensing Program Analysts (LPA’s) L. Ibo & K. Nguyen arrived unannounced to conduct an annual required/infection control inspection. LPAs met with Program Director Adrienne Phillips and informed the purpose the visit.

LPAs toured the facility with Adrienne Phillips the facility is providing activities remotely and also started in-house activities for about 10% of licensed capacity. LPAs inspected facility indoor. Facility does not handle clients' cash resources. LPAs observed a central screening location for COVID-19 with hand sanitizer by the entrance door.

Fire extinguishers checked and observed fully charge; tags 11/2021.

LPAs observed the following:
1. Bathrooms/toilets have 2 trash bins, both trash bins have no lid, LPAs provided technical assistance and recommended to have all trash change to trash bin with lid, LPAs requested for a picture to be sent to CCL by 3/7/2022.

2. expired emergency food supplies, staff discarded all the expired food, LPAs requested a picture of new emergency food supplies to send to CCL office on or before 3/7/2022

No deficiency cited during the visit.

Exit interview conducted and copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2022
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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