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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005920
Report Date: 08/02/2022
Date Signed: 08/02/2022 11:10:32 AM

Document Has Been Signed on 08/02/2022 11:10 AM - 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:
08/02/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:29 AM
MET WITH:TIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Albert Marin made an unannounced visit to this facility. LPA was granted entry after completing the Coronavirus 2019 screening procedure. Via phone, LPA spoke with Licensee Kevin Clark and Administrator (AD) Ken Leonard stated the purpose of the visit.

On August 1, 2022, Community Care Licensing Division (CCLD) Orange Office, received an incident report from the facility describing that on July 30, 2022 Client 1 got out of the facility unattended.

For this visit, LPA Marin toured the interior and exterior portions of facility which included but not limited to client's bedrooms and common areas. After the tour, LPA conducted interviews and file review.

Due to insufficient information, this visit will be completed at a later time.

LPA Marin conducted a phone exit interview with Administrator Ken Leonard. LPA discussed the additional documents needed. AD agreed to provide the documents to Licensee for review. LPA also did a phone exit interview with Licensee Clark. LPA stated the additional documents needed. Licensee agreed to provide documents to CCLD as soon as they become available. AD granted permission for staff 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: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2022
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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