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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606198
Report Date: 02/16/2024
Date Signed: 02/16/2024 03:43:13 PM

Document Has Been Signed on 02/16/2024 03:43 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:DESTINY NADEAUFACILITY TYPE:
775
ADDRESS:1463 E LOS ANGELES AVETELEPHONE:
(805) 520-8744
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY: 45CENSUS: 21DATE:
02/16/2024
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
01:52 PM
MET WITH:Destiny Nadeau & Riley BreenTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility unannounced to conduct a required annual visit. The LPA met with Administrator and explained the reason for the visit. .

The LPA toured the physical plant areas at approximately 2pm, 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 were serviced in 6/2023.

Common Activity Space: The facility is a two-story structure with activity rooms, a conference room, two (2) bathrooms, offices, and a food service area. The second floor includes administrative offices and conference rooms. The LPA did not observe any obstructions or hazards. Fire extinguishers were charged and serviced 6/2023. Systems are checked bi-annually. Activities: Activities are designed for individual and as a group. The LPA observed staff working with consumers. Food Service: The kitchen area was clean and in good condition. Consumers bring their meals and store in the refrigerator. Restrooms: Restrooms were clean and sanitary. Hot water temperature measured at 112.5 F.

Files: At approximately 2:45pm, staff and client files were reviewed. Staff and client files observed with required documents according to Title 22.

The LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed.

No deficiencies were observed. Exit interview conducted and a copy of the report

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2024
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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