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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200131
Report Date: 01/17/2025
Date Signed: 01/17/2025 03:54:16 PM

Document Has Been Signed on 01/17/2025 03:54 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: 8DATE:
01/17/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:John Carswell, Campus AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 01/17/2025, at 11:15 am, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Case Management visit regarding an incident that was reported to Community Care Licensing Division (CCLD) on 01/07/2025. LPA met with Campus Administrator, John Carswell, and explained the reason for the visit.

The incident reported that Client (C) C1 and C2 (both roommates) were bitten by bed bugs and transported to the Emergency Room to be examined. LPA interviewed Staff (S) S1. S1 stated that pest control came out the same day to inspect the rooms and confirmed that there were bed bugs. S1 stated that pest control completed a treatment for bed bugs the same day and that staff double bagged all items, laundered clothes at high heat and closed off the infected rooms for the next three (3) weeks. S1 stated that C1 and C2 returned back to the facility and were moved to a different bedroom.

No deficiencies issued during the visit.

Exit interview conducted and a copy of this report was provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2025
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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