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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608828
Report Date: 12/12/2023
Date Signed: 12/12/2023 02:03:56 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/12/2023 02:03 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: 18DATE:
12/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Leticia CampbellTIME COMPLETED:
02:05 PM
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Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection visit. LPA was greeted by reception staff and Administrator Leticia Campbell was contacted. The administrator present on site.

Leticia Campbell greeted LPA Smith and LPA disclosed purpose of visit. Leticia revealed there are 18 clients participating in the program today. Clients greeted LPA Smith as they departed program for the day.

At 1:14 pm, LPA Smith toured the building with Leticia Campbell. The facility is a single story building with a kitchen, a media room, fitness room, quiet room, arts and craft room, computer room, salon, breakroom and five (5) restrooms. Restrooms have the following items available: hand soap, paper towels, and trash cans.

Facility common spaces and work areas, and furniture observed to be clean and in good repair.

There are approximately four (4) fire extinguishers throughout the facility observed to be charged

Infection control plan reviewed and available upon request

There are no deficiencies to report at this time.

Exit Interview Conducted /Copy of the Report Issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2023
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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