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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200139
Report Date: 08/01/2024
Date Signed: 08/01/2024 12:11:25 PM

Document Has Been Signed on 08/01/2024 12:11 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 TO CHOICES DAY SERVICESFACILITY NUMBER:
079200139
ADMINISTRATOR/
DIRECTOR:		JUAN B. VELASQUEZFACILITY TYPE:
775
ADDRESS:751 BELMONT WAYTELEPHONE:
(510) 724-9042
CITY:PINOLESTATE: CAZIP CODE:
94564
CAPACITY: 60CENSUS: 6DATE:
08/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Nadia Valdovinos, DIRECTORTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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An unannounced 1 year required inspection was conducted by Licensing Program Analyst (LPA) Carol Fowler on 08/01/24 starting at 9:45am. During the visit, LPA met with Program Director, Nadia Valdovinos. LPA inspected the day program inside and out including but not limited to: activity room(s), conference room, storage area, kitchen and bathroom(s).

LPA observed the entire day program had constant supervision throughout the facility.

The day program was at a comfortable temperature. Hot water temperature was measured at 105 degrees Fahrenheit. Day programs do not distribute or handle any medications. No bodies of water. Fire drill was last conducted on 07/30/24 and emergency disaster plan is implemented and dated 01/12/24. Day program is well ventilated with appropriate lighting & bathrooms.

Facility has trained staff that meet the clients' needs.

LPA reviewed staff records and observed that all have criminal record clearances and associated with the facility. Clients’ records were organized and filed properly. Day Program does not store or handle clients medication/ does not centrally store medication.

continue on LIC809C
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 08/01/2024
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CONTINUE FROM LIC 809

The following forms to be updated and submitted to CCL by 08/08/2024:

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



No deficiencies. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
LIC809 (FAS) - (06/04)
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