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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005920
Report Date: 02/24/2022
Date Signed: 02/24/2022 02:53:11 PM

Document Has Been Signed on 02/24/2022 02:53 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ALLIED PATHWAYS CARE HOME LLCFACILITY NUMBER:
306005920
ADMINISTRATOR:LEONARD, KENFACILITY TYPE:
735
ADDRESS:27341 LAS NIEVESTELEPHONE:
(818) 384-9331
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 4CENSUS: 4DATE:
02/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:House Manager Keegan CunninghamTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Albert Marin made an unannounced required annual inspection in this facility. Via phone, LPA Marin spoke to Licensee (LE) Gerald Jones and stated the purpose of this visit. Home Manager (HM) Keegan Cunningham arrived in the facility shortly after.

The facility is a single level structure and licensed for four ambulatory only.

About 1:45 PM, LPA Marin was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. For this visit, LPA observed two clients in care and two staff members on the floor. LPA toured the interior and exterior portions of the facility. There were four private client's rooms. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke, carbon monoxide, and auditory exit alarms were tested to be operational. Bathrooms were observed to be in good repair. Hot water was measured at 107 degrees Fahrenheit. Facility met the minimum two day supply of perishable and seven day supply of non-perishable food stock requirements. Medications, cleaning supplies and sharp items were inaccessible to clients in care. Facility had supplies of personal protective equipment in place. Fire extinguisher was mounted and charged. For the exterior portion, facility had garden furniture in good repair; and grounds were free of tripping hazards. LPA Marin reviewed the COVID 19 mitigation plan of the facility.

For this visit, no immediate threat on the health and safety of clients in care was observed.

LPA Marin conducted an phone exit interview with Licensee (LE) Gerald Jones ; LE gave permission to have HM Cunningham to sign and receive the report. Copy of this report was left in the facility.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Albert Marin
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2022
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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