<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200131
Report Date: 02/25/2022
Date Signed: 02/25/2022 03:59:31 PM

Document Has Been Signed on 02/25/2022 03:59 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:PATHWAY, THEFACILITY NUMBER:
079200131
ADMINISTRATOR:TRAVIS CURRANFACILITY TYPE:
772
ADDRESS:550 PATTERSON BLVD.TELEPHONE:
(925) 938-8050
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY: 16CENSUS: 13DATE:
02/25/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Gabriel Flores, Program DirectorTIME COMPLETED:
04:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 02/25/22 at 1:25 PM Licensing Program Analysts (LPAs) L. Holmes and L. Francisco arrived unannounced to conduct a case management visit on this date to follow-up on an incident report that was faxed to CCL on 2/4/22. LPAs met with Gabriel Flores, Program Director and explained the purpose of the visit.

Based on record review and interview during today’s visit. S1 had an inappropriate relationship with C1. On 02/03/22, S2 was informed by C1 that C1 was in a relationship with staff. Once S2 was made aware of the relationship, S2 notified S4. Facility conducted an internal investigation on 02/04/22. Consequently, S1 emailed facility on 02/04/22 admitting to having an inappropriate relationship with C1 and expressed of wanting to give a two weeks notice. However, once facility was informed, S1 was terminated immediately. C1 was discharged on 02/22/22.

LPAs obtained the following documents during visit:
  • Staff training
  • Staff schedule
  • Client roster
  • Company policy
  • S1 training record


The following documents to be submitted to CCL no later than 02/28/22.
  • Physician's report
  • Care plan
  • Discharge notes

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2022
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 1