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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601162
Report Date: 08/08/2023
Date Signed: 08/08/2023 12:39:44 PM

Document Has Been Signed on 08/08/2023 12:39 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
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SOCIAL VOCATIONAL SERVICES INC (SSF)FACILITY NUMBER:
415601162
ADMINISTRATOR:NAVARRO, CZARINAFACILITY TYPE:
735
ADDRESS:192 BEACON STREETTELEPHONE:
(650) 877-7255
CITY:SOUTH SCAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: 60CENSUS: DATE:
08/08/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:Masai DavisTIME COMPLETED:
01:10 PM
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On 8/8/2023, Licensing Program Analyst (LPA) Grace Donato conducted an announced Pre-Licensing Inspection visit. LPA met with Director of Regional Administration, Masai Davis.

LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. LPA observed the indoor and the outdoor passageways are free of obstruction. This is a single level facility. All rooms are observed with required furniture and lighting, bathrooms to be odor-free and in good repair. Water temperatures was measured at 110F. Room temperature is at 68F.

Activity rooms are observed to be comfortable, spacious and free from any tripping hazards. Facility lighting is sufficient for comfort and safety. LPA toured the kitchen area and observed it to be clean and in good repair. Facility refrigerator temperatures are within regulatory standards. First aid kit is observed as in place and new. Chemicals and toxins were observed to be in a janitorial closet. It is observed as locked and inaccessible to clients.

All fire prevention systems such as sprinklers, smoke detectors, carbon monoxide detectors, fire extinguishers, and fire control panel have been inspected in place.

Facility is clean and in good repair based on observations made today. Facility is in compliance with Title 22 regulations. No citations are issued.

A copy of report is provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2023
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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