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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606198
Report Date: 04/03/2023
Date Signed: 04/03/2023 02:16:27 PM

Document Has Been Signed on 04/03/2023 02:16 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, 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: 18DATE:
04/03/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:36 PM
MET WITH:Riley Breen, Assistant Program Coordinator TIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced Case Management - Incident inspection. At 12:36 p.m., the LPA met with Assistant Program Coordinator, Riley Breen and explained the reason for the visit.

The reason for today's inspection is to follow up on a self-reported incident received on 03/27/2023. The report pertains to Client #1 (C1) reporting possible sexual abuse by other individuals. At 12:44 p.m., the LPA conducted an interview with the Assistant Program Coordinator. At 12:58 p.m., the LPA obtained copies of pertinent documents. At 2:07 p.m., the LPA along with the Assistant Program Coordinator conducted a physical plant tour.

No immediate health and safety concerns were observed during today's inspection.

Further investigation is required at this time. A referral was made to Community Care Licensing Division's (CCLD) Investigation Branch (IB) and was accepted on 03/30/2023. The investigation is assigned to Investigator Laura Garcia. Additional report may follow if warranted.

Exit interview conducted. A copy of the report was provided via print and email.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2023
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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