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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200139
Report Date: 08/18/2022
Date Signed: 08/18/2022 10:29:17 AM

Document Has Been Signed on 08/18/2022 10:29 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:PATHWAY TO CHOICES DAY SERVICESFACILITY NUMBER:
079200139
ADMINISTRATOR:JUAN B. VELASQUEZFACILITY TYPE:
775
ADDRESS:751 BELMONT WAYTELEPHONE:
(510) 724-9042
CITY:PINOLESTATE: CAZIP CODE:
94564
CAPACITY: 60CENSUS: 3DATE:
08/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Nadia Valdovinos, Program DirectorTIME COMPLETED:
10:45 AM
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On 8/5/2022 Licensing Program Analyst (LPA) C. Fowler arrived unannounced to conduct an Infection Control Inspection. LPA knocked at the front door and went to side gate entry to try and enter the facility no one answered the door or gate. LPA called the facility there was no answer then LPA called Nadia Valdovinos ED and was informed the facility is open part-time Tuesdays and Thursdays 9:00am to 12pm

On 08/18/2022 at 9:30AM, Licensing Program Analyst (LPA) C. Fowler arrived unannounced to conduct Infection Control Inspection. LPA met with Program Director, Nadia Valdovinos and explained the purpose of the visit. Day program operates from 9:00am to 12:00pm. There were 4 staff observed working with the 3 clients here today.

LPA toured facility with Nadia Valdovinos Program Director including but not limited to, multiple activity rooms, kitchen, bathrooms, office space, and the outside recreational area. Participants are served snacks. Emergency supplies, including water were observed. Cleaning supplies are locked and inaccessible to participants. There are no bodies of water or fire safety hazards observed. Restrooms are maintained in safe and in sanitary operating condition, and additional equipment for the physically handicapped was observed. Incontinent clients are kept clean and dry, and the facility is free of odors.

The following forms to be updated and submitted to CCL by 08/25/2022:

LIC 308 Designation of Administrative Responsibility
LIC 309 Administrative Organization
LIC 610 Emergency Disaster Plan

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2022
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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