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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 126803615
Report Date: 08/26/2022
Date Signed: 08/26/2022 11:48:46 AM

Document Has Been Signed on 08/26/2022 11:48 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:PATHWAYSFACILITY NUMBER:
126803615
ADMINISTRATOR:RANKIN, LEAHFACILITY TYPE:
772
ADDRESS:2370 BUHNE STREETTELEPHONE:
(707) 442-5721
CITY:EUREKASTATE: CAZIP CODE:
95501
CAPACITY: 16CENSUS: 13DATE:
08/26/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Leah RankinTIME COMPLETED:
12:00 PM
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At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility, unannounced, to conduct a case management visit in regards to two SOC341 forms submitted by facility on 06/09/2022 and 08/16/2022. LPA met with Program Administrator Leah Rankin, interviewed staff and reviewed records.
The incident on 06/09/2022, was in regards to 2 clients getting into a physical altercation in their shared bedroom. Facility staff separated the individuals and moved one client to a different room. There was no history of aggression between the two prior to this incident. There have been no further incidents. Facility handled the incident per regulation and notified all responsible parties.

The incident reported on 08/16/2022 was in regards to a former staff allegedly taking money from a client during an outing. LPA reviewed financial documents, interviewed clients and staff. Based on accounting records, the money that was returned to the business office did not match the receipt amounts. The reconciliation of money and receipts was not conducted as the policy dictated, but there is no evidence that suggests the money was taken by staff.

No citations issued.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2022
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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