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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 126803615
Report Date: 12/15/2021
Date Signed: 12/15/2021 10:25:35 AM

Document Has Been Signed on 12/15/2021 10:25 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:PATHWAYSFACILITY NUMBER:
126803615
ADMINISTRATOR:RANKIN, LEAHFACILITY TYPE:
772
ADDRESS:2370 BUHNE STREETTELEPHONE:
(707) 442-5721
CITY:EUREKASTATE: CAZIP CODE:
95501
CAPACITY: 16CENSUS: 14DATE:
12/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Leah RankinTIME COMPLETED:
10:30 AM
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At approximately 08:30 AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an Annual Required infection control inspection. This inspection will focus on the Infection Control procedures and practices of this facility. LPA met with Administrator Leah Rankin.

Upon arrival to the facility, LPA had temperature and oxygen levels checked and was asked health related questions. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident bedrooms and common areas were inspected. Fire Extinguishers were found to be charged and inspected within the last 12 months. Facility Posters are in place at the entrance and throughout the building. Facility has PPE supplies. Residents wear masks inside the facility when attending groups. LPA observed all staff were wearing masks during this visit.

There were no deficiencies found in the areas inspected.

No citations issued.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2021
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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