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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601162
Report Date: 09/08/2023
Date Signed: 09/08/2023 05:57:24 PM

Document Has Been Signed on 09/08/2023 05:57 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:
775
ADDRESS:192 BEACON STREETTELEPHONE:
(650) 877-7255
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: 60CENSUS: 40DATE:
09/08/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:51 PM
MET WITH:Jaimel CalanoTIME COMPLETED:
02:30 PM
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On 9/8/2023, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced case management visit to follow up on an incident that was reported to CCLD on 9/5/2023. LPA met with Program Director Jaimel Calano and explained the purpose of the visit.

CCLD received report that a client eloped during the day program. Client left the premises around 1:35 pm and was eventually found around 9:40 pm at a different location.

LPA interviewed staff and stated that they weren't aware of any eloping tendencies of the client. They were only made aware after this incident after it happened in the facility. The facility were client resides advised them after this incident. Facility is now on alert with regards to the clients needs.

In-service training for staff is scheduled and facility will send LPA a copy of the log and training outline.

No deficiency cited during today's visit.

This report was reviewed and copy has been provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2023
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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