079200139-4-20-2023-15-AS-BFOG-CRV4JZ-20230515190934

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200139
Report Date: 04/20/2023
Date Signed: 04/20/2023 11:34:54 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/17/2023 and conducted by Evaluator Carol Fowler

COMPLAINT CONTROL NUMBER: 15-AS-20230417142614

FACILITY NAME:	PATHWAY TO CHOICES DAY SERVICES		FACILITY NUMBER:	079200139
ADMINISTRATOR:	JUAN B. VELASQUEZ		FACILITY TYPE:	775
ADDRESS:	751 BELMONT WAY		TELEPHONE:	(510) 724-9042
CITY:	PINOLE	STATE: CA	ZIP CODE:	94564
CAPACITY:	60	CENSUS: 4	DATE:	04/20/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Nadia Valdovinos, Program Director		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff abused client in care

Staff did not maintain proper ratios

INVESTIGATION FINDINGS:

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On 04/20/2023 at 10:00AM, Licensing Program Analyst (LPA), C. Fowler arrived unannounced to conduct the 10-day initial visit and deliver complaint findings for the allegation above. LPA met with Nadia Valdovinos, Program Director, and explained the reason for the visit.

Upon arrival LPA observed 4 participants having snack. LPA interviewed two (2) staff, one (1) via phone call and reporting party (RP). LPA requested and reviewed the following documents: IPP/ISP, preplacement appraisal, physician report, consumer support notes, Identification and emergency information, consumer emergency form and attendance roster.

Based upon LPA record review and interviews with (RP) and staff S1 and S2 revealed that there was no abuse of a consumer in care. Record review revealed that there was 3 consumers assigned to 1 staff. Therefore the allegations above are UNSUBSTANTIATED.

Continued on LIC9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20230417142614

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: PATHWAY TO CHOICES DAY SERVICES	FACILITY NUMBER: 079200139
	VISIT DATE: 04/20/2023

NARRATIVE

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Continued from LIC9099

Based upon records review and interviews conducted, the Department has investigated the above allegations and found that they are Unsubstantiated. A finding that the complaint allegation/s are Unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

Exit interview conducted and a copy of this report provided

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

LIC9099 (FAS) - (06/04)

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