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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200383
Report Date: 02/25/2025
Date Signed: 02/25/2025 01:25:16 PM

Document Has Been Signed on 02/25/2025 01:25 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: 32DATE:
02/25/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Masai Davis, SVS Regional DirectorTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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On 02/25/25 at 1PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 2/20/25. LPA met with SVS Regional Director (SRD) and explained the purpose of the visit.

SRD stated that SVS Concord Adult Day Program has a total of 32 participants, 6 of the clients are non-ambulatory and 24 are ambulatory. SRD stated that clients alternate between attending the Adult Day Program and in Community Based Program activities. SRD stated that SVS Concord Adult Day Program facility had extensive water damage overnight on 02/09/25 when water flooded the unit due to a faulty sprinkler system. With SVS Concord still under repairs, SRD stated all clients are currently doing Community Based Program activities. SRD stated it may take approximately one to two months for repairs to be completed. SRD stated they will keep Community Care Licensing (CCL) informed of a more definitive timeline of when facility will be back in operation. Regional Center of the East Bay (RCEB) was notified of the 02/09/25 incident but not Community Care Licensing (CCL).

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted. A copy of appeal rights and this report was provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2025
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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Document Has Been Signed on 02/25/2025 01:25 PM - It Cannot Be Edited


Created By: Daisy Panlilio On 02/25/2025 at 01:21 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: SVS CONCORD ADULT DAY PROGRAM
FACILITY NUMBER: 079200383

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/14/2025
Section Cited
CCR
82061(a)(1)

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Upon the occurrence, during the hours the day program is providing services to the client, of any of the events specified in Section 82061(a)(1), a report shall be made to the licensing agency within the agency's next working day during its normal business hours. In addition, a written report containing the information specified in Section 82061(a)(2) shall be submitted to the licensing agency within seven days following the occurrence of the event.
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By POC due date, SRD agreed to conduct in-service staff retraining on reporting requirements in compliance with Title 22 Section 82061 regulations.
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This requirement was not met as evidenced by the failure of facility staff to timely report the 02/09/25 water damage incident that closed the Adult Day Program facility within the prescribed timeline which caused a potential health & safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Bennett Fong
LICENSING EVALUATOR NAME:Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:
DATE: 02/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2025


LIC809 (FAS) - (06/04)
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