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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609983
Report Date: 07/13/2022
Date Signed: 07/13/2022 02:03:47 PM

Document Has Been Signed on 07/13/2022 02:03 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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:PATHPOINTFACILITY NUMBER:
197609983
ADMINISTRATOR:VANDENBERG, KARENFACILITY TYPE:
775
ADDRESS:8510 BALBOA BLVD. STE. 100TELEPHONE:
(805) 868-9908
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 45CENSUS: 22DATE:
07/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Karen VandenbergTIME COMPLETED:
02:10 PM
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On 07/13/22 at 1:00 p.m Licensing Program Analyst (LPA) Joscelyn Martinez arrived at the facility to conducted an unannounced infection control visit. LPA met with Program Coordinator Karen Vandenberg and the purpose of the visit was explained.

Upon entrance LPA’s temperature was taken and asked to sign in. LPA toured the physical plant. Covid-19 signs are posted throughout the facility and inside the bathrooms. Facility has a total of three bathrooms designated for client’s use and all were observed to have the necessary toiletries. Hand sanitizing stations are located throughout the facility. Facility has an area with office space used for administrative work that is inaccessible to clients. Fire extinguisher has a service date of 04/15/22. LPA obtained facility’s last fire inspection.

The day program is currently offering virtual, in person, and home visit program activities. The facility has two large activities room and one room designated as the media room which is utilized for the virtual activities. Clients were observed practicing social distancing in the activities room. All staff were observed with masks.

No deficiencies cited. Exit interview conducted. Report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Joscelyn Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2022
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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