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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700394
Report Date: 06/26/2023
Date Signed: 06/26/2023 01:11:10 PM

Document Has Been Signed on 06/26/2023 01:11 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:PATHWAY TO CHOICES SAC BMPFACILITY NUMBER:
342700394
ADMINISTRATOR:MOORMAN, DIANAFACILITY TYPE:
775
ADDRESS:7723 OLD AUBURN RDTELEPHONE:
(916) 735-5968
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 60CENSUS: 15DATE:
06/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Claudia Romero, Associate Director TIME COMPLETED:
01:10 PM
NARRATIVE
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Licensing Program Analysts (LPA's) Sabrina Calzada and Jaynae Boyles arrived unannounced to conduct an annual inspection. LPA's met with Claudia Romero, Associate Director, and explained purpose of inspection. There are fifteen (15) clients and (5) staff and the Associate Director today at the Adult Day Program (ADP). Program operates on a 1:3 staff ratio and is vendorized through the regional center.

LPA's and Associate Director toured the interior and exterior of the facility including but not limited to the office, kitchen, six (6) client classrooms, client bathrooms, isolation room, garden and patio. LPA's observed the facility to be clean, safe and in good repair. LPA's observed locked toxins and sharps in the kitchen.LPA's observed multiple fire extinguishers to have been last serviced 12/23/22. LPA's observed picnic tables with umbrellas outside next to the basketball court and soccer field. Facility conducts monthly fire drills and passed the annual fire inspection in November 2022.

LPA's tested water temperature at 117*F in the kitchen and observed several first aid kids on site. LPA's observed bathrooms to be clean and contain paper towels, soap. 20-second hand-washing posters to be posted in each bathroom. LPA's observed 30+day PPE supplies throughout.

LPA's reviewed Infection Control Plan and found it to be comprehensive. LPA's reviewed (2) client files and (2) staff files and found them to contain required information. Discussed SOC341- facility to conduct training. Discussed Emergency Disaster Plan and reviewed LIC610E completed. Facility to update LIC610-E and complete 9 page version. LPA's reviewed Director's file and did not observe (30) hours of documented continuing education within the last 24 months. LPA's requested updated copy of LIC308.

Per California Code of Regulations Title 22, Division 6, Chapter 8, the following (1) deficiency is cited on the 809D page.
Exit interview with Associate Director and Patty Remos, Program Manager . Copy of report and appeal rights provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2023
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
Document Has Been Signed on 06/26/2023 01:11 PM - It Cannot Be Edited


Created By: Sabrina Calzada On 06/26/2023 at 12:52 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PATHWAY TO CHOICES SAC BMP
FACILITY NUMBER: 342700394

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82064(d)(1)
Administrator - Qualifications and Duties
(d) The administrator shall receive and document a minimum of 30 clock hours of continuing education every 24 months of employment.

(1) Continuing education shall include completion of courses related to roles and responsibilities of the administrator position including, but
not limited to, workshops, seminars, and academic classes.

This requirement is not met as evidenced:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 out of 1 Administrator files, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/17/2023
Plan of Correction
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Licensee/Administrator agrees to review prior completed trainings within the last 24 months and ensure that (30) hours of required continuing education has been completed. If (30) hours has not been completed, within last (24) months, Director to complete any missing hours. Director to provide documentation of (30) hours by 7/17/2023 and contact LPA if additional time is needed.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maribeth Senty
LICENSING EVALUATOR NAME:Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:
DATE: 06/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/26/2023


LIC809 (FAS) - (06/04)
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