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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 207201518
Report Date: 06/13/2022
Date Signed: 06/13/2022 09:25:41 AM

Document Has Been Signed on 06/13/2022 09:25 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, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:SVS OAKHURST ADULT DAY PROGRAMFACILITY NUMBER:
207201518
ADMINISTRATOR:CHRISTINE LAWRENCEFACILITY TYPE:
775
ADDRESS:49234 GOLDEN OAK DRIVETELEPHONE:
(559) 692-2922
CITY:OAKHURSTSTATE: CAZIP CODE:
93644
CAPACITY: 75CENSUS: 37DATE:
06/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Annette Brade - Regional DirectorTIME COMPLETED:
09:40 AM
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On 06/13/22, Licensing Program Analyst (LPA) M. Yang arrived at facility unannounced to conduct Annual Inspection- Infection Control. LPA met with Regional Director Annette Brade.

LPA toured facility inside and out. All passageways and exits were clear and free from obstruction. Social distancing and cough etiquette postings observed. LPA observed small amount of PPE supplies in facility. 30 days PPE supplies storage in a central location. LPA observed fire extinguisher served date: 01/18/22. LPA toured four activity rooms. All spaces had adequate seating and lighting. Facility kitchen was clean and serviceable. Bathrooms were odor free, clean and serviceable. All bathrooms observed trash bin with lid. Hand washing posting were observed by bathroom sinks.

A sample of client records reviewed to have updated emergency contact information.

No deficiencies cited during the inspection.



Exit interview conducted. A copy of the report was provided to the licensee.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2022
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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