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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608828
Report Date: 12/03/2021
Date Signed: 12/03/2021 11:40:25 AM

Document Has Been Signed on 12/03/2021 11:40 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:SVS LANCASTER ADULT DAY PROGRAMFACILITY NUMBER:
197608828
ADMINISTRATOR:LETICIA CAMPBELLFACILITY TYPE:
775
ADDRESS:846 W. LANCASTER BLVD.TELEPHONE:
(661) 729-5954
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 75CENSUS: 0DATE:
12/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:LETICIA CAMPBELLTIME COMPLETED:
11:45 AM
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LPA Spaeth conducted an unannounced visit to the location and observed the COVID signs posted on the entrance to the facility. LPA was greeted by the receptionist who was wearing a mask and recorded LPA's temperature and LPA was instructed to sign in. LPA observed hand sanitizer, wear your mask sign, sign in sheet for visitors and staff, and available masks.

LPA was then greeted by Leticia Campbell, Administrator at 10:30 am. Administrator confirmed the offices are housed by staff members and clients do not report to the facility location. However, clients are transported in the facility's vans for work projects. The Administrator confirmed drivers are sanitizing the vans several times a day and clients' daily temperatures are recorded when entering the van.

At 11:40 am, LPA and the Administrator began the tour of the building. LPA observed all staff members were wearing masks. LPA observed several offices where staff members were working and two large rooms where staff members were social distanced while performing office tasks. LPA observed hand sanitizer throughout the building and COVID signs posted. LPS observed the break room which contained two round tables with only one chair per table. Two staff members were eating and were social distanced within the room.

LPA observed there are five bathrooms which all contained wash your hands sign, hand sanitizer, paper towels, and trash cans. The entire facility was neat and clean. LPA also observed an adequate supply of PPE including surgical masks, N-95 masks, Lysol spray, sanitized wipes. The Administrator showed LPA a plastic container which contained hand sanitizer, sanitized wipes, masks, gloves, and thermometer. The Administrator also showed a check list which staff members use when going out in the field. Administrator also stated the facility is sanitized by staff members every hour and the building is professionally cleaned three a week. At 11:28 am, LPA observed a staff member sanitizing the doorknobs.
There are no deficiencies to report at this time. Exit interview conducted, appeal rights discussed, and a copy of the report was given to the Administrator.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2021
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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