435202331-7-15-2026-26-AS-MMOR-DVZPWU-20260715114120

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435202331
Report Date: 07/15/2026
Date Signed: 07/15/2026 11:41:36 AM

Document Has Been Signed on 07/15/2026 11:41 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME:	SVS GILROY ADULT DAY PROGRAM		FACILITY NUMBER:	435202331
ADMINISTRATOR/ DIRECTOR:	ALISON NOBLE		FACILITY TYPE:	775
ADDRESS:	7101 MONTEREY ROAD		TELEPHONE:	(408) 843-9630
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY: 60		CENSUS: 54	DATE:	07/15/2026
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:10 AM
MET WITH:	Staff Debbie Silva		TIME VISIT/ INSPECTION COMPLETED:	11:45 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On July 15, 2026, Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced case management - incident visit regarding an incident report regarding resident R1. LPA met with Staff Debbie Silva and explained the purpose of the visit. On June 24, 2026, the Department received an incident report (IR) regarding resident R1. The IR stated the following: on June 19, 2026, resident R1’s family member (FM) called the facility to report that R1 had a big bruise on the inside of his/her right arm. R1 told FM it happened the on June 18, 2026, wherein a staff grabbed him/her and the bruise was the result. On July 10, 2026, Licensing Program Analyst Manuel Monter interviewed R1. R1 did not respond to questions posed by LPA and did not provide any relevant information regarding the allegation. On July 10, 2026, Licensing Program Analyst Manuel Monter interviewed Staff S2-S4. 3 Out of 3 staff (S2-S4) stated they have not observed S1 ever holding, grabbing resident R1 in a rough manner or hitting R1. S2 stated the incident occurred allegedly on June 18th. 2 Out of 3 staff, (S2, S3) stated they are aware of an incident, weeks prior to June 18, 2026 where R1 had yelled that he/she was going to get staff S1 fired. Staff S2 stated this incident was not documented by staff.

NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Manuel Monter
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: SVS GILROY ADULT DAY PROGRAM	FACILITY NUMBER: 435202331
	VISIT DATE: 07/15/2026

NARRATIVE

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On July 13, 2026, Licensing Program Analyst Manuel Monter interviewed staff S1, S5, S6. S1 stated a few weeks prior, there was a time when R1 was leaving the activity room and he/she tapped R1 in the back and asked where R1 was going. R1 responded, “Don’t touch me.” In a rough tone. S1 stated after this incident, R1 would proclaim that he/she that S1 was going to be fired. S1 stated R1 was also upset that S1 had on occasions redirected R2. S1 denied the allegation that he/she grabbed/squeezed or harmed R1. S1 stated he/she did not touch R1.

S5 stated he/she has not observed any instance where S1 grabbed/squeezed R1’s arm or any instance where S1 hurt R1. S5 stated a few months ago, he/she has had the experience where R1 became upset with him/her and also had proclaim that he/she was going to get fired.

S6 stated R1 gets hyper focused on what bothers him/her and will hold a grudge. S6 stated she was aware and had observed the 2 instances where R1 had proclaimed that staff S1 and S5 would be fired, prior to June 18, 2026. S6 stated he/she isn’t aware of any instance where staff S1 grabbed R1 in a rough manner. S6 stated he/she never witnessed any incident of staff physically abusing R1. S6 stated R1 is very vocal when something happens and would have screamed if something occurred.

On July 13, 2026, Licensing Program Analyst Manuel Monter interviewed Witness W1. W1 stated he/she spoke to R1 regarding how he/she obtained the bruise. W1 stated, R1 had told him/her: he/she was in the kitchen when S1 had grabbed his/her arm. W1 stated this retelling from R1 was not consistent with what he/she had told the facility.

On July 15, 2026, Licensing Program Analyst Manuel Monter interviewed residents R2-R4. R2 and R3 stated he/she has not observed any staff hitting/hurting/ grabbing in a rough manner residents in the day program. LPA interviewed Resident R4. R4 did not provide a response to questions posed by LPA and did not provide relevant information regarding the allegation.

NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Manuel Monter
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026

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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: SVS GILROY ADULT DAY PROGRAM	FACILITY NUMBER: 435202331
	VISIT DATE: 07/15/2026

NARRATIVE

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On July 15, 2026, Licensing Program Analyst Manuel Monter interviewed staff S7. S7 stated she did not work with R1 on June 18, 2026. S7 stated Staff S1 and staff S3 were in the group with R1 on June 18, 2026. S7 stated she has not observed any staff hitting/hurting/ grabbing in a rough manner residents in the day program.

The Department reviewed resident R1's Individual Needs and Services Plan dated March 31, 2026. The plan states R1 has self injurious behaviors such as punching his/her stomach and picking his/her head.

Although it is a fact that Resident R1 sustained a bruise, there is not a preponderance of evidence to show that resident R1’s bruise was a result of staff actions. Based on investigation, records reviewed, and interviews conducted, the Department found that the allegation to be UNSUBSTANTIATED.

No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Staff Debbie Silva and a copy of the report was provided.

NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Manuel Monter
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026

LIC809 (FAS) - (06/04)

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