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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200675
Report Date: 06/10/2024
Date Signed: 06/10/2024 12:09:50 PM

Document Has Been Signed on 06/10/2024 12:09 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/
DIRECTOR:		PIER, RONFACILITY TYPE:
775
ADDRESS:6602 OWEN DRIVE SUITE 100TELEPHONE:
(925) 621-3902
CITY:PLEASANTONSTATE: CAZIP CODE:
94588
CAPACITY: 60CENSUS: 79DATE:
06/10/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Adrienne Phillips, Program DirectorTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On 6/24/24 at 10:45AM, Licensing Program Analyst (LPA) K. Nguyen conducted a Health and Safety check as a result of the department receiving a priority 2 complaint.

During the health and safety check, LPA observed a total of 4 staff members and 2 clients at the Day program. LPA toured day program with case manager, including but not limited to multiples activities room, kitchen, bathroom, and common areas. Clients in care appear to be safe and there are no imminent health/safety concerns on today's date.

No deficiencies cited during the health and safety check. 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: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2024
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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