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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197602666
Report Date: 06/25/2025
Date Signed: 06/25/2025 02:07:22 PM

Document Has Been Signed on 06/25/2025 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:PATHPOINTFACILITY NUMBER:
197602666
ADMINISTRATOR/
DIRECTOR:		JENSEN, JAMESFACILITY TYPE:
775
ADDRESS:348 E AVENUE K 4 STE BTELEPHONE:
(661) 723-7484
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 90CENSUS: 83DATE:
06/25/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Nicolas WilliamsTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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At 09:15 a.m. on 06/24/2025, Licensing Program Analyst (LPA) Lorena Casillas conducted an unannounced case management visit. LPA met with the Program Coordinator (PC) Nicolas Williams and disclosed the reason for the visit.

Today’s case management visit is to follow up on an unusual incident previously reported on 05/30/25 by the facility in which the facility was made aware via a concerned citizen phone call that a staff member, Staff #1 (S1), driving Van #215, allegedly hit and dragged Client #1 (C1) out of Van #215 in the parking lot of a Taco Bell. The purpose of the visit is to obtain additional information regarding this incident.

LPA interviewed Program Coordinator (PC), Assistant Program Coordinator (APC), staff member #1 (S1), Client #1 (C1), Client #2 (C2) and Client #3 (C3) from 09:30 am to 2:00 pm.

Continued on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Lorena Casillas
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/25/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: PATHPOINT
FACILITY NUMBER: 197602666
VISIT DATE: 06/25/2025
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It is reported that on 5/30/25 a call to the facility was received from a member of the public reporting an alleged assault involving a staff member operating Van 215. The caller stated that the staff member had reached into the passenger side of the van, grabbed the individual and punched him in the face, pulled him by the shirt, and forcibly removed him from the vehicle. The individual was then reported to have run into a nearby Taco Bell. The caller was asked for the description of the staff member and individual and it was later determined that the parties involved were S1 and C1. LPA interviewed PC and it was revealed that PC and APC, immediately when made aware of the situation, were able to contact human resources to GPS locate the vehicle. Upon locating the vehicle PC and APC went to the location to assess the situation, when they arrived, they observed the group at a distance and did not notice anything out of the ordinary. When the group was approached by PC and APC, C1 did not appear to be in distress, nor were any visible bruises or injuries observed. S1, C1, C2, and C3 were interviewed separately by PC and APC. It was discovered by interviews that C1 opened the van door prematurely prompting S1 to raise their voice in alarm to instruct C1 to close the van door. This prompted C1 to get upset and upon S1 asking C1 to exit the vehicle C1 became slightly hesitant. C1 while still seated in the vehicle became resistant to exiting and pulled their body backwards, this prompted S1 to grab C1 by the shirt to avoid C1 from injuring themselves. C1 proceeded to attempt to throw their glasses and S1 prevented that by using their hand to stop C1 from successfully throwing their glasses. Once the situation was under control the group proceeded to enter Taco Bell without further incident. PC and APC both stated that clients that were interviewed by them, all stated that there was no physical abuse nor was there any yelling beyond S1 displaying alarm at the immediate danger. PC reported that they went back to the Taco Bell to attempt to gain access to video surveillance and although a copy was not able to be obtained, PC was allowed by general manager to view the surveillance tape. According to what PC reports, the video surveillance does not show any incident of violence or abuse towards any clients. The video surveillance did reflect the group arriving and entering the Taco Bell without incident. LPA interviewed Client #2 and Client #3 that attended the outing at the time of the alleged incident and they both corroborated what PC and APC reported, there was no incident other than C1 opening the door and S1 raising their voice to have C1 close to door.

Continued on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Lorena Casillas
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: PATHPOINT
FACILITY NUMBER: 197602666
VISIT DATE: 06/25/2025
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 LPA interviewed S1 via phone, who also corroborated what PC and APC reported stating that they never hurt any of the clients, S1 simply redirected C1 to wait for S1 to open the van door. LPA interviewed C1 and C1 stated that they like S1 but C1 was not able to provide details of any incidents. LPA inquired if C1 had ever been hurt by any staff members and C1 denied ever being hurt. LPA interviewed C2 and C3 and both denied S1 ever hurting them or any other clients. LPA Casillas interviewed the General Manager at Taco Bell who stated that based on surveillance video there is no observation of any type of abuse nor did staff report to have witnessed any abuse. APC stated that additional reminders have been provided for all staff to further ensure that proper care and supervision is being provided at all times to all clients in care.

Since the Program Coordinator has taken the appropriate actions to ensure that the incident was thoroughly investigated, provided additional staff reminders and made the appropriate reports, there are no deficiencies cited at this time.

Exit interview conducted. Copy of report provided.

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Lorena Casillas
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025
LIC809 (FAS) - (06/04)
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