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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445202381
Report Date: 02/16/2023
Date Signed: 02/16/2023 11:56:33 AM

Document Has Been Signed on 02/16/2023 11:56 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 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: 60DATE:
02/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Karina NorthTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Karina North, Program Director.

During visit, LPA Marrufo toured the facility. A visitor screening area was observed. The facility was observed to have a 30-day supply of PPEs. Cleaning supplies were observed in a locked storage area. The outdoor exits were observed to be clear of obstructions. 4 out of 4 client bathrooms were observed to have available soap, paper towels, trash bins with lids, and hand washing signs.

No deficiencies were cited at this time as per California Code of Regulations Title 22.

This report was reviewed with Program Director Karina North and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023
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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