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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200675
Report Date: 07/12/2024
Date Signed: 07/12/2024 11:23:36 AM

Document Has Been Signed on 07/12/2024 11:23 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
OAKLAND ASC, 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: 56DATE:
07/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:26 AM
MET WITH:Adrienne PhilipsTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 7/12/2024 at 9:26 AM., Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator Adrienne Philips Program Director and explained the purpose of the visit. Day program operates from 7:00 a.m. to 3:00 p.m. Monday to Friday. There were 16 staff observed working at the program today.

LPA toured facility including but not limited to: activity rooms, kitchen, bathrooms, office space, and the outside area. Clients bring their own lunches and snacks are provided by the program. Emergency supplies, including water were observed. The hot water temperature in the kitchen measured 115.5 degrees Fahrenheit. Cleaning supplies are locked and inaccessible to clients. Medications are not handled/dispensed by this program. There are no bodies of water or fire safety hazards observed. Restrooms are maintained in safe and in sanitary operating condition, and additional equipment for the physically handicapped was observed. Incontinent clients are kept clean and dry, and the facility is free of odors. The program has 14 vans used for client outings and transportation. Emergency disaster drills are conducted on a bi-weekly basis at different times by each instructor. Fire extinguishers throughout facility were last inspected 01/09/2024. First aid kit was checked and observed to be complete.

LPA reviewed 5 clients records and 5 staff records, and all were complete.

No deficiencies were cited during this inspection. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2024
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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