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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202331
Report Date: 12/12/2024
Date Signed: 12/31/2024 09:16:44 AM

Document Has Been Signed on 12/31/2024 09:16 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 PROGRAMFACILITY NUMBER:
435202331
ADMINISTRATOR/
DIRECTOR:		ALISON NOBLEFACILITY TYPE:
775
ADDRESS:7101 MONTEREY ROADTELEPHONE:
(408) 843-9630
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 60CENSUS: DATE:
12/12/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Ruby Duran, Daniel Raborar, Merita Amituanai, Masai DavisTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 12/12/2024 San Bruno Regional Office - San Jose Unit conducted a non-compliance conference meeting with Ruby Duran Program Director, Daniel Raborar Case Manager, Merita Amituanai Regional Director, Masai Davis Director of Regional Administration.

Present in the meeting were Regional Manager Vivien Helbling, Licensing Program Manager Jackie Jin, Licensing Program Manager Romeo Manzano, Licensing Program Analyst Christine Dolores, Licensing Program Analyst David Marrufo, and Licensing Program Analyst Simi Rai.

During the non-compliance meeting, the following serious violations were discussed: 82072(a)(3) - Personal Rights; 82087 - Responsibility for Providing Care and Supervision; and 82075 - Health Related Services.

During visit, the complaint on 10/31/2024 was briefly discussed. Civil penalties will be reviewed for serious bodily injuries. Final report will be delivered to the facility.

During this meeting, the compliance plan was developed and discussed with the licensee which includes more frequent monitoring inspection visits to ensure compliance with this compliance plan and Title 22 Regulations for 2 years. Licensee was provided the link below for resources and guidance to improve facility operations:
https://www.cdss.ca.gov/inforesources/community-care/resource-guide-for-providers.

This report was reviewed with Ruby Duran Program Director, Daniel Raborar Case Manager, Merita Amituanai Regional Director, Masai Davis Director of Regional Administration and a copy of the report and LIC9111 was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2024
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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