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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197602666
Report Date: 03/07/2022
Date Signed: 03/07/2022 11:17:35 AM

Document Has Been Signed on 03/07/2022 11:17 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:PATHPOINTFACILITY NUMBER:
197602666
ADMINISTRATOR:JENSEN, JAMESFACILITY TYPE:
775
ADDRESS:348 E AVENUE K 4 STE BTELEPHONE:
(661) 723-7484
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 90CENSUS: 7DATE:
03/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Nicholas Williams, Program CoordinatorTIME COMPLETED:
11:30 AM
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At 10:00am, Licensing Program Analyst (LPA) Shira Stamps, met with Nicholas Williams (Program Coordinator) for an annual visit. Entrance interview conducted.

Physical plant: At 10:05am, LPA and Program Coordinator toured the facility. LPA observed table and chairs to be in adequate repair. LPA observed there to be no obstructions of passageways. Wall and floors were adequate, clean, and in good repair. Equipment and supplies used for day program appear to be in good repair. All trash cans were observed to have lids. The facility maintains a comfortable temperature at 70 F. The last annual fire alarm test was conducted on 2/07/22 by the 5 Alarm Fire Corporation.

The kitchen area: LPA observed the two kitchen areas to be adequately clean. Consumers bring their own snacks.

The bathrooms: LPA observed the bathrooms to be clean and have the wash your hands signs posted. The hot water temperature measured in women’s bathroom at 105 F. Trash cans in all bathrooms have lids to protect consumers from cross contamination.

The First Aid kit was observed. Five fire extinguishers were observed to be full and last serviced on 12/02/21.
The facility does not assist with any consumer medications at this time. LPA observed cleaning supplies and PPE in the locked hallway closet.

Administration: LPA collected the LIC 500 and Consumer Roster. LPA collected the required documents for an Administrator change. LPA will update LIS.

Exit Interview Conducted. Copy of report delivered to Program Coordinator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2022
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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