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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609983
Report Date: 05/15/2024
Date Signed: 05/15/2024 12:58:21 PM

Document Has Been Signed on 05/15/2024 12:58 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:PATHPOINTFACILITY NUMBER:
197609983
ADMINISTRATOR/
DIRECTOR:		VANDENBERG, KARENFACILITY TYPE:
775
ADDRESS:8510 BALBOA BLVD. STE. 100TELEPHONE:
(805) 868-9908
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 45CENSUS: 18DATE:
05/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Debra Ingram-Office Manager/HR SpecialistTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 05/15/24, at 9:05 a.m., Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, annual visit. LPA was met by Office Manager/HR Specialist-Debra Ingram.

LPA asked for the census, participant, and staff files. The staff and participant files are digital and are not directly accessible to the LPA.

The physical tour started at 10:25 am and LPA observed the following:

Common Areas: At approximately 10:25am, LPA and Office Manager toured the facility. There is one (1) large activity room that can be divided by a divider to become two (2) activity rooms. LPA observed proper tables and chairs for the participants. All trash cans were observed to have lids. The facility maintains a temperature at 73F. There is a large conference room for meetings. There is another room for storage.



The bathrooms: LPA observed three (3) bathrooms to be clean and have the wash your hands signs posted. One (1) of the bathrooms has a shower that can be used for the participant. Another bathroom has a changing table for incontinence participants. And one (1) bathroom does not have a shower or incontinence change table. The bathrooms have grab bars. The hot water temperature tested in the bathroom is with in required range between 109-119F. Trash cans in all bathrooms have lids. The First Aid kits were observed to be complete. There are two (2) first aid kits.

Two (2) fire extinguishers observed to be full and last serviced on 05/2024. One (1) is located by the conference room and the other one (1) by the activity room.

809C-continued
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: PATHPOINT
FACILITY NUMBER: 197609983
VISIT DATE: 05/15/2024
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Kitchen area: LPA observed the kitchen area to be adequately clean. The facility has two (2) refrigerators for participant use. The facility does not keep any food for participants. The participants bring their own breakfast/lunch/dinner. There are two (2) microwaves for participant use. There are no knives or chemicals in this area. There is another kitchen for staff where sharps are kept and inaccessible to participants.

Medications: There are no medications that are kept at this facility.

There are five (5) main exit doors. There are four (4) vehicles for transportation into the community/emergency purpose. There are several smoke detectors and fire sprinklers through out the facility.

Administration: The Infection control were reviewed and there was Covid 19 signs on the wall, hygiene sanitation signs, Emergency and Disaster Plan, Rights of Individuals with Developmental Disabilities, Facility Sketch, Ombudsman. There was different types of Earthquakes and Fire Drill which are conducted every month.

An exit interview was conducted, no citations were issued, and a copy of this report was given to the Office Manager.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
LIC809 (FAS) - (06/04)
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