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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157204153
Report Date: 07/25/2022
Date Signed: 07/25/2022 02:07:32 PM

Document Has Been Signed on 07/25/2022 02:07 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, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:PATHPOINTFACILITY NUMBER:
157204153
ADMINISTRATOR:WHITE, SHAWNFACILITY TYPE:
775
ADDRESS:4701 STOCKDALE HWYTELEPHONE:
(661) 617-6170
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 60CENSUS: 31DATE:
07/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Shawn White, AdministratorTIME COMPLETED:
02:25 PM
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On 7/25/22 at 12:40 PM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual inspection. LPA was greeted by staff, granted entry, and given Covid screening. LPA met with Administrator Shawn White. Facility uses two main entry points. Clients enter through back facility door. All visitors enter through front doors. Both have screening set-ups.

Facility was observed clean and without any obstructions or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing and masking is maintained in the common areas. Cleaning and PPE supplies were checked. Residents files have updated emergency contact information.

No deficiencies cited during inspection.

The following forms are to be submitted to CCL within 2 weeks:

LIC500, LIC610D

Exit interview conducted. A copy of this report was given to Administrator Shawn White, whose signature confirms receipt of this report.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2022
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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