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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 126803615
Report Date: 11/01/2023
Date Signed: 11/01/2023 11:07:43 AM

Document Has Been Signed on 11/01/2023 11:07 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: 14DATE:
11/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Leah RankinTIME COMPLETED:
11:20 AM
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At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a required annual inspection and met with Administrator Leah Rankin. This facility is at the same address as a locked Mental Health Resource Center. LPA toured the building and grounds and found all areas of the facility to be kept clean and in good repair. LPA observed all exits and walkways were unobstructed. There are multiple client rooms, and all areas contained required furniture and appliances were found in good working order. Toxins and cleaners are stored in a locked facility janitorial room and in locked cabinets in the laundry room. Water temperature measured within regulation between 105 and 120 degrees F at faucets accessible to clients. LPA toured the main kitchen in which meals for all campus programs are provided. The pantry was heavily stocked with fresh and nonperishable foods, as well as emergency supplies. LPA observed back up linens and personal hygiene supplies for clients on hand. The facility has vehicles for transportation which are serviced monthly. LPA observed medications are stored in a locked medication room. Medications were locked and inaccessible. Centrally stored medication records, along with progress notes and care plans are kept on a computer database with all client information. LPA reviewed 9 of 14 client files and found all clients have current assessments indicating all client's needs and services and current physician's reports. LPA reviewed Centrally Stored medication records and Medication Administration records (MARS) and found them to be filled out appropriately. Staff were found to have current first aid and CPR certification. Emergency drills are performed monthly and cover various types of emergencies. The last documented drill was conducted on 10/23/2023.

No deficiencies were found in the areas inspected, No citations issued.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2023
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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