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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202331
Report Date: 03/06/2025
Date Signed: 03/06/2025 09:30:58 AM

Document Has Been Signed on 03/06/2025 09:30 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: 42DATE:
03/06/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Michele PagsisihanTIME VISIT/
INSPECTION COMPLETED:
09:35 AM
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Licensing Program Analyst (LPA) Christine Kabariti arrived at the facility unannounced to conduct a case management – other visit. LPA met with Program Director Michele Pagsisihan.

The purpose of the visit is to hand deliver immediate exclusion letters for two staff members, S1 and S2 who the Department determined engaged in conduct inimical.

The immediate exclusion letters for S1 and S2 was handed to the Program Director.

Program Director confirmed S1 and S2 was not currently working in the facility and was terminated. The Program Director was informed to remove S1 and S2 from any contact with clients and not allow S1 and S2 to be physically present in the facility.

LPA advised to separate S1 and S2 from the facility roster.

No deficiencies were cited per California Code of Regulations, Title 22.

This report was reviewed with Program Director Michele Pagsisihan and a copy of the report was provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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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