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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606198
Report Date: 01/31/2022
Date Signed: 02/02/2022 02:04:15 PM

Document Has Been Signed on 02/02/2022 02:04 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:PATHPOINTFACILITY NUMBER:
197606198
ADMINISTRATOR:KIM WHITAKERFACILITY TYPE:
775
ADDRESS:1463 E LOS ANGELES AVETELEPHONE:
(805) 520-8744
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY: 45CENSUS: 8DATE:
01/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:19 PM
MET WITH:Lorri RaymondTIME COMPLETED:
01:33 PM
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Licensing Program Analyst (LPA) Teresa Camara arrived at the facility unannounced to conduct a required annual visit at 12:19 p.m. This annual had a specific emphasis on infection control practices and procedures. The LPA met with Administrative Assistant Lorri Raymond and explained the reason for the visit. Program Coordinator Destiny Nadeau called in to provide information as well.

The LPA toured the physical plant areas to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The carbon monoxide detectors and smoke alarms are tested bi-annually by Bay Alarms and the fire extinguishers are serviced annually by Frontier Fire and checked monthly by facility staff.

KITCHEN: Knives and cleaning supplies are stored in nearby locked cabinets and closets. The facility has a sufficient supply of non-perishable emergency food and water.

RESTROOMS: Restrooms are clean and sanitary and in operating condition.

COMMON SPACES: At the time of the visit, furnishings were observed to be in good condition. The LPA observed the required postings throughout the facility.

INFECTION CONTROL: During today’s visit, the LPA spoke with the Program Coordinator and Administrative Assistant regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening and sanitation station. All facility staff were observed wearing masks. The LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility has appropriate plans in place in the event of clients and/or staff showing symptoms of COVID or testing positive for COVID.

No deficiencies were observed. Exit interview conducted and a copy of the report emailed to Program Manager Brianna Berry and Vice President Glynda Givens..

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2022
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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