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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200383
Report Date: 04/24/2024
Date Signed: 04/24/2024 02:37:01 PM

Document Has Been Signed on 04/24/2024 02:37 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 CONCORD ADULT DAY PROGRAMFACILITY NUMBER:
079200383
ADMINISTRATOR/
DIRECTOR:		SHAVILA WRIGHTFACILITY TYPE:
775
ADDRESS:2300 STANWELL DRIVE SUITE BTELEPHONE:
(925) 849-8750
CITY:CONCORDSTATE: CAZIP CODE:
94520
CAPACITY: 60CENSUS: 23DATE:
04/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:35 PM
MET WITH:Shanay McDonald, Program DirectorTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On 4/24/2024 at 12:35pm, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct an Annual 1-year required inspection. LPA met with Shanay McDonald, Program Director, and explained the reason for the visit. The facility's fire clearance was approved for 40 ambulatory and 20 non-ambulatory clients.

LPA inspected the facility with Program Director, which included but not limited to the bathrooms, kitchen, and common areas. LPA observed the facility to be free of odor, clean and in good repair. Outdoor space is provided and is free of hazards. There is a comfortable room temperature of 71 degrees Fahrenheit for clients in care. Grab bars mats were observed in bathrooms and throughout the facility. Clients bring their own lunches and snacks to facility. The hot water temperature in the shared bathroom measured 115.0 degrees. All observed toilets and hand washing stations are maintained in a safe, sanitary, operating condition. There are no bodies of water or fire safety hazards observed. Carbon monoxide and smoke detectors found to be in working order. Toxins and sharp objects were locked and inaccessible to clients. Emergency disaster plan last updated on 4/24/2024. Fire extinguisher last services 6/5/2023. Fire drill last conducted 11/22/2023. First aid kit was checked and is complete.

LPA reviewed five (5) staff files and all are current and complete. LPA reviewed six (6) clients files.

Continued on LIC809C.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 CONCORD ADULT DAY PROGRAM
FACILITY NUMBER: 079200383
VISIT DATE: 04/24/2024
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Continued from LIC809.

The following forms to be updated and submitted to CCLD by 5/1/2024:
  • LIC308 Designation of Administrative Responsibility
  • LIC500 Personnel Record

No deficiencies were cited during this inspection.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024
LIC809 (FAS) - (06/04)
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