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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 419210075
Report Date: 12/08/2023
Date Signed: 12/08/2023 01:36:43 PM

Document Has Been Signed on 12/08/2023 01:36 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:SVS, SAN MATEO ADULT DAY PROGRAMFACILITY NUMBER:
419210075
ADMINISTRATOR:AUSTIN HALLAHANFACILITY TYPE:
775
ADDRESS:914 S. CLAREMONT STREETTELEPHONE:
(650) 375-1713
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY: 90CENSUS: 51DATE:
12/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Administrator, Andrea TaufaTIME COMPLETED:
01:45 PM
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On December 8, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual inspection. LPA met with Program Director, Andrea Taufa and Regional Director, Maria Navarro and explained the purpose of the visit.

LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. There are 9 activity/classroom areas which includes but is not limited to; art, computer, library, exercise, game. Rooms were observed to be clean, clear from tripping hazards, and spacious. LPA observed clients participating in activities or eating their lunches. LPA observed 4 offices and 2 conference rooms. 1 changing room was observed to be clean.

LPA observed six single bathrooms to be clean and odor-free. Hot water temperature measured at 108-110 degrees F throughout the facility. LPA toured the kitchen and observed it to be clean. Chemicals, toxins and sharps were locked in the janitor's closet. According to the Program Director, clients either bring their lunches or staff assist with buying clients lunch. Clients are able to store their lunches in the refrigerator. According to the Program Director, the day program does not have any clients who take medication while they are at the day program.

A comfortable temperature is maintained throughout the facility and lighting is sufficient for comfort. LPA checked all fire extinguisher which were charged and inspected on 03/2023. First aid kit was observed to be present. Carbon monoxide detectors were observed to be in working condition.

No citations are issued during this visit. Report is reviewed with Program Director and Regional Director and a copy is provided.
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2023
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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