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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202789
Report Date: 10/03/2024
Date Signed: 10/03/2024 01:57:27 PM

Document Has Been Signed on 10/03/2024 01:57 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, 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: 50DATE:
10/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:52 PM
MET WITH:Victoria GreenTIME VISIT/
INSPECTION COMPLETED:
02:20 PM
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On 10/03/24, Licensing Program Analysts (LPAs) M. Medina and R. Bruce conducted an unannounced Case Management visit. LPAs introduced self, stated purpose of visit and allowed entrance. LPAs met with Program Director, Victoria Green and stated purpose of visit.

This Department received a report for an incident that occurred on 8/09/24 involving R1 and R2. LPA Medina requested and received a copy of each residents IPP during facility visit.

A second report was received 9/06/24 involving R3. LPA requested and received R3 IPP, staff training records, facility notes, and personnel paperwork.


SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2024
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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