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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200675
Report Date: 11/16/2023
Date Signed: 11/16/2023 03:20:24 PM

Document Has Been Signed on 11/16/2023 03:20 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: 60DATE:
11/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Adrienne Phillips, Program DirectorTIME COMPLETED:
03:45 PM
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On 11/16/2023 at 12:15pm, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct an Annual 1-year required inspection. LPA met with Adrienne Phillips, Program Director, Program Manager, and explained the reason for the visit.

The facility was inspected, including but not limited to the various function rooms, kitchen, bathrooms, storage and the receiving area. LPA observed a quiet room, art room, game room, exercise/movie room, library, and kitchen/dining room for the clients' use. The facility operates from 7:00 AM-3:00 PM, with many clients out in the community throughout the day for group activities or job contracts. 3 out of 60 clients work in a cross-win Church in the community Monday and Friday for maximum of 2 hours. The facility provides training and activities to clients in daily living skills, such as social skills, personal hygiene, cooking, and simple homemaking tasks.

Clients bring their own food, however supply of emergency food was available. No medications or cash were handled in this facility. Comfortable temperature was maintained inside the facility at 71 degrees Fahrenheit. Disinfectants and cleaning supplies were kept locked in a storage closet. There were adequate lights in the facility for the comfort and safety of the clients. Hot water temperature measured at 115 degrees Fahrenheit. Restrooms were observed clean and sanitary with soap and paper towels available for clients. The staff to client ratio is 2 staff to 6 clients. Last earthquake drill was last conducted on 9/15/23 and is conducted every month. Fire extinguisher last services 7/20/2023. Fire drill last conducted 7/21/2023. First aid kit was checked and is complete. The facility provides clients with transportation and currently has seven operating vehicles.
No deficiencies were cited during this inspection.
Exit interview conducted and a copy of this report provided via email.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
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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