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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445202381
Report Date: 05/05/2022
Date Signed: 05/05/2022 06:40:11 PM

Document Has Been Signed on 05/05/2022 06:40 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
CCLD Regional Office,
, CA
FACILITY NAME:SVS WATSONVILLE ADULT DAY PROGRAMFACILITY NUMBER:
445202381
ADMINISTRATOR:ALISON NOBLEFACILITY TYPE:
775
ADDRESS:1875 MAIN STREETTELEPHONE:
(831) 707-2280
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 60CENSUS: 15DATE:
05/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Karina North TIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Marybeth Donovan conducted an unannounced Required - 1 Year Annual Inspection to include Infection Control site visit and met with Karina North Program Director. 66 Clients are enrolled in the program. Today 15 clients are in a community based activity. The other clients are participating in a virtual day program. The Program operates 5 days a week, Monday - Friday.

LPA toured the facility inside and out. The facility has a designated isolation room. All fire exit routes were free and clear of obstructions. Sharp objects, toxins, cleaning supplies are secured.

Facility observed to have designated entry point for COVID 19 symptom screening. Hand sanitizer available to visitors and clients. Bathrooms observed to be supplied with hygiene products. Hand Washing signs posted in the bathrooms. Foot operated trash containers observed in the bathrooms.

LPA observed supply of Personal Protective Equipment (PPE). COVID 19 signs posted included COVID 19 Screening Symptoms, Social Distancing, Stop the Spread, Corona Virus: What We Should Know and Masking,

LPA reviewed the facility policies and procedures to include screening, masking, testing, isolation and disinfecting,

No citations were issued per the California Code of Regulations Title 22.

LPA reviewed report with Karina North Program Director and a copy provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Marybeth Donovan
LICENSING EVALUATOR SIGNATURE: DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2022
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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