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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157204153
Report Date: 07/29/2024
Date Signed: 07/29/2024 01:16:25 PM

Document Has Been Signed on 07/29/2024 01:16 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/
DIRECTOR:		WHITE, SHAWNFACILITY TYPE:
775
ADDRESS:4701 STOCKDALE HWYTELEPHONE:
(661) 617-6170
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 60CENSUS: 44DATE:
07/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:06 AM
MET WITH:Shawn White and Joy BowersTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct the Annual Inspection. LPA met with and explained the purpose of the visit with Administrator (AD) Shawn White and Program Coordinator II (PC) Joy Bowers.

During this visit, LPA toured the day program with AD and PC. Individuals were observed participating in program activities throughout the common area. The program grounds are clean and in good repair. LPA observed required postings throughout. Bathrooms contained required LPA observed the common area, classrooms, kitchen and bathrooms to be clean. Paper goods, cleaning and disinfection supplies were observed to be locked in a supply closet. Doorways and passageways are unobstructed throughout the facility. Fire Extinguishers serviced 7/19/2024 by Brandco, Fire drill conducted 7/2/24 and Disaster Drill on 7/19/24. Monthly staff training is conducted and documented. This facility does not currently store or assist any individuals with medications. There is a designated room with locking cabinets if needed. The facility Emergency Disaster and Infection Control Plans were reviewed. LPA conducted staff and individual record reviews during the inspection.

There were no citations during this inspection.

LPA requested the following updated forms faxed to CCLD by 8/5/23: Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Personnel Report (LIC 500), Client Roster (LIC 9020), Proof of current Liability Coverage, Emergency Disaster Plan (Lic610D (12/21), Infection Control Plan with Infection Control Lead Certification.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE: DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2024
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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