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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608828
Report Date: 10/23/2024
Date Signed: 10/23/2024 02:32:15 PM

Document Has Been Signed on 10/23/2024 02:32 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:SVS LANCASTER ADULT DAY PROGRAMFACILITY NUMBER:
197608828
ADMINISTRATOR/
DIRECTOR:		LETICIA CAMPBELLFACILITY TYPE:
775
ADDRESS:846 W. LANCASTER BLVD.TELEPHONE:
(661) 729-5954
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 75CENSUS: 24DATE:
10/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:33 AM
MET WITH:Leticia CampbellTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 10/23/2024, Licensing Program Analysts (LPAs) Angelica Segovia and Gary Tan conducted an unannounced Required Annual Inspection and met with the Administrator, Leticia Campbell. LPAs stated the reason for their visit. Facility was toured inside and out. LPAs observed the following: the facility is a single-story building, with Administration offices, classrooms, bathrooms, kitchen, and staff lounge. The facilities capacity is seventy-five (75) clients, and during the inspection, twenty-four (24) clients were present. The licensed facility has a fire clearance for sixty (60) ambulatory clients and fifteen (15) non-ambulatory.

At approximately 9:40 AM, the physical plant tour was conducted alongside Administrator Campbell. During the inspection, LPA observed front entrance with a reception area which also serve as a sanitizing station. First-aid kit located in reception area and observed to be equipped with but not limited to: bandages, scissors, digital thermometer, tweezer, and manual. The facility’s mailing room, exercise room, computer room, arts and craft, common areas, media room, salon, lounge, and kitchen were inspected. The facility maintains a comfortable temperature of 74°F. Each room is provided comfortable furnishing and equipment. Client personal lockers are provided if needed. The kitchen is equipped with appropriate fixtures and locked cabinets. Lunch is not provided by program. Medication is not kept or administered to clients. Bathrooms were clean, and handicap accessible. Water temperature in client bathrooms were measured at a range of 111.2 degrees Fahrenheit to 115.7 degrees Fahrenheit. No bodies of water located at this facility.

(continued on LIC 809-C)

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SVS LANCASTER ADULT DAY PROGRAM
FACILITY NUMBER: 197608828
VISIT DATE: 10/23/2024
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(Continued from LIC 809)

Fire extinguishers are located throughout the building, were fully charged and last inspected on 12/20/2023. Smoke and fire alarms are hardwired and interconnected with a pull system directly connected at the local fire department. Fire Equipment inspection was last conducted on 5/3/2024. Carbon monoxide detector was observed in the reception area. Pull stations are located at the front and back entrance of the facility. The facility is equipped with sprinkler system. Fire drills are conducted monthly. The last emergency drill was conducted on 9/3/2024. In addition to the physical plant inspection, staff and client records were reviewed and observed to be complete and updated.

Pursuant to title 22, Division 6, Chapter 3, there were no health and safety hazard observed during the day's inspection. No citations issued at this time. An exit interview was conducted, and a copy of this report issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
LIC809 (FAS) - (06/04)
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