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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609983
Report Date: 07/07/2023
Date Signed: 07/07/2023 06:48:15 PM

Document Has Been Signed on 07/07/2023 06:48 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,
, CA
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: 19DATE:
07/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Karen Vandenberg & Natasha OchaTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Zabel Chochian conducted an annual inspection at the facility. The LPA met with Administrator Karen Vandenberg and Assistant Program Coordinator Natasha Ocha and the reason for the visit was explained.

Physical plant: At approximately 10am, LPA, Administrator and Assistant Program Coordinator toured the facility. LPA observed table and chairs to be in adequate repair. LPA observed there to be no obstructions of passageways. Wall and floors were adequate, clean, and in good repair. Equipment and supplies used for day program appear to be in good repair. All trash cans were observed to have lids. The facility maintains a comfortable temperature at 71 F. The last annual fire alarm test was conducted on 1/14/2023 by the Fire Safety & Solutions Corporation. Kitchen area: LPA observed the kitchen area to be adequately clean. Program has two refrigerators for consumer and staff use. The bathrooms: LPA observed three (3) bathrooms to be clean and have the wash your hands signs posted. The hot water temperature tested in the bathroom is with in required range (105F-120F) 109F. Trash cans in all bathrooms have lids to protect consumers from cross contamination. The First Aid kit was observed complete. Two fire extinguishers observed to be full and last serviced on 05/19/23. The facility does not assist with any consumer medications at this time. LPA observed cleaning supplies, paper towels, toilet paper and PPE in the locked storage room.
Staff and Consumer files reviewed from 11am-1pm. Personnel and training records observed for five out of five staff files reviewed. Consumer records reviewed: Admission agreements, medical assessments, Service Plans and Individual Program Plan. Program is in the process of transitioning to a E-file system and therefore file review process took longer than expected to account for all required records for staff and consumers. Copy of an updated Personnel Report (LIC 500) and Consumer roster obtained. Vehicle maintenance records observed. Facility observed to be in compliance. No deficiencies cited during visit today.

Exit Interview Conducted. Copy of report provided to Administrator.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE: DATE: 07/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2023
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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