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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202789
Report Date: 07/02/2024
Date Signed: 07/02/2024 01:35:41 PM

Document Has Been Signed on 07/02/2024 01:35 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:SVS BAKERSFIELD ADULT DAY PROGRAMFACILITY NUMBER:
157202789
ADMINISTRATOR/
DIRECTOR:		GREEN, VICTORIA A.FACILITY TYPE:
775
ADDRESS:3601 UNION AVETELEPHONE:
(661) 323-0533
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93305
CAPACITY: 90CENSUS: DATE:
07/02/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Victoria Green, Program DirectorTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
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Licensing Program Analyst Lissett Padgett (LPA) arrived unannounced to conduct a case management inspection. LPA explained the reason for the visit and met with Program Director (PD) Victoria Green.

LPA is following up on self reported Incident that occurred on 06/25/2024. The incident alleged a Personal Rights violation involving one client (C1) and one staff (S1). This facility placed (S1) on leave pending an internal investigation.

During this visit LPA interviewed Program Director Victoria Green, Staff (S1) to the incident. LPA attempted to speak with C1 but C1 did not verbalize what occurred on 6/25.

LPA obtained C1 facility documents for further review.

Based on interviews, no further review is needed at this time. LPA will return if new information is received.

No deficiencies were observed or cited during this visit.

Exit interview conducted, report signed and copy of this report provided for facility records.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Lissett Padgett
LICENSING EVALUATOR SIGNATURE: DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2024
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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