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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608828
Report Date: 12/14/2022
Date Signed: 12/14/2022 01:35:48 PM

Document Has Been Signed on 12/14/2022 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
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:
12/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:LETICIA CAMPBELLTIME COMPLETED:
01:30 PM
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LPA Spaeth conducted an unannounced annual visit and was greeted by the Regional Director at 12:15 pm. Upon entering the location, LPA observed the COVID signs on the doors. LPA's temperature was recorded and LPA signed in at the sign in station. The Regional Director confirmed there are no clients reporting to the day program building but the clients are participating in community activities. Staff also conduct Zoom meetings with clients.

LPA and the Director began the tour at 12:30 pm until 12:45 pm. LPA observed all staff were wearing masks. There are five bathrooms at the location which all contained wash your hands sign, hand soap, paper towels, and a trash can.

There are several staff offices located throughout the building. The offices were neat and clean. LPA observed staff members were working in their offices and were wearing masks.

The kitchen and break room are spacious rooms with tables that were social distanced. The exercise room and arts and craft room were also used as office space for staff. LPA observed two staff members were social distanced and working in these locations.

LPA observed a 90-day supply of N-95 masks, surgical masks, surgical gowns, and gloves. The Regional Director confirmed the frequently touched surfaces are sanitized every hour.

There are no deficiencies to report at this time. Exit interview conducted, and a copy of the signed report was given to the Director.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2022
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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