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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200131
Report Date: 02/18/2025
Date Signed: 02/18/2025 05:03:32 PM

Document Has Been Signed on 02/18/2025 05:03 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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:PATHWAY, THEFACILITY NUMBER:
079200131
ADMINISTRATOR/
DIRECTOR:		CARSWELL, JOHNFACILITY TYPE:
772
ADDRESS:550 PATTERSON BLVD.TELEPHONE:
(925) 938-8050
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY: 16CENSUS: 9DATE:
02/18/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:19 PM
MET WITH:John Carswell, Campus AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:20 PM
NARRATIVE
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On 02/18/2025 at 1:19 PM Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Case Management visit. LPA met with Campus Administrator, John Carswell and Program Director, Paulette Alonsagay.

While LPA L. Alexander was conducting a complaint investigation (15-AS-20240926145843) on 02/18/2025. During interviews with staff and record review LPA observed that Residents (R) R1, R2 and R3 were evicted and that proper eviction procedures were not followed. The Department did not receive proper notification when R1, R2 and R3 were issued 30 day eviction notices.

The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties.

Exit interview conducted. A copy of this report and appeal rights provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 02/18/2025 05:03 PM - It Cannot Be Edited


Created By: Lori Alexander-Washington On 02/18/2025 at 01:59 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: PATHWAY, THE
FACILITY NUMBER: 079200131

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/18/2025
Section Cited
CCR
81068.5

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81068.5 Eviction Procedures
(a) The licensee shall be permitted to evict a client with 30 days' written notice for any of the following reasons.....

This requirement is not met as evidenced by:
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Administrator agreed to self-certify that they read and understood the regulation moving forward. In addition, Administrator will conduct an Eviction Procedures In-Service training with staff and will send a copy of attendance sign-in sheet to CCLD by POC due date.
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Based on interviews and record review, the licensee did not comply with the section cited above in by not complying with eviction procedures with residents (R) in care (R1, R2 and R3) that included proper notice of reasonings to evict, documentation, notices sent to authorized representatives, mental health professionals and responsible parties and notice to the Department within five days of giving the notice to the client, which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Bennett Fong
LICENSING EVALUATOR NAME:Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:
DATE: 02/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/18/2025


LIC809 (FAS) - (06/04)
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