392701110-1-14-2025-27-AS-KLES-DCWR82-20250114114712

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 392701110
Report Date: 01/14/2025
Date Signed: 01/14/2025 11:48:12 AM

Document Has Been Signed on 01/14/2025 11:48 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	LIFE PATHWAY VOCATIONAL DEVELOPMENT CENTER		FACILITY NUMBER:	392701110
ADMINISTRATOR/ DIRECTOR:	ENUNWA, JOHN		FACILITY TYPE:	775
ADDRESS:	9305 THORNTON ROAD SUITE E		TELEPHONE:	(310) 953-1378
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY: 30		CENSUS: 10	DATE:	01/14/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	ENUNWA, JOHN		TIME VISIT/ INSPECTION COMPLETED:	12:00 PM

NARRATIVE

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Licensing Program Analysts (LPA) Kesha Lewis arrived at this facility unannounced to conduct a Required 1 Year Annual Inspection Visit. LPA was met by staff and administrator joined about 15b minutes later explained the purpose of the visit.

LPA and administrator inspected the physical plant including but not limited to the resident bathrooms, and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations. Facility is a day program with a current census of 10. There is entry door is leading to a common area, with a hallway to the bathrooms and eating area. Chemicals and noted to not be locked to residents in care the program has no medications. LPA also conducted the care tool.

Hot water temperature was measured at 119 F degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees Fahrenheit. LPA observed the following posted on the facility wall: Facility license, sketch, See Something Say Something poster, Ombudsman poster, Theft and Loss Policy, Resident Bill of Rights, Rights of Resident/Family Councils.

The facility submitted a LIC 808 mitigation plan, which was approved. The facility has central entry point.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LIFE PATHWAY VOCATIONAL DEVELOPMENT CENTER	FACILITY NUMBER: 392701110
	VISIT DATE: 01/14/2025

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Resident areas were sanitary and had the required furniture and furnishings.

LPA observed no fire extinguishers at the facility and current, smoke and carbon monoxide detectors, central heating and air in the facility. The first aid kit was found in compliance containing at least the following: a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency, sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and Antiseptic solution.

LPA reviewed two (2) staff files. All staff is fingerprint cleared and associated to the facility and staff have current First Aid or CPR certifications on file. Facility is conducting initial and continuing training as required.

LPA reviewed three (3) resident facility files, COVID-19 Plan, and survey binder. All necessary documents were in place.

Exit interview held with staff and copies of reports left at conclusion of visit.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/14/2025 11:48 AM - It Cannot Be Edited

Created By: Kesha Lewis On 01/14/2025 at 09:58 AM

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: LIFE PATHWAY VOCATIONAL DEVELOPMENT CENTER	FACILITY NUMBER: 392701110
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/14/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80020(a)

80020(a) Fire Clearance. All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	based on observation there were no Fire extinguishers in the facility at the time of visit.
	POC Due Date: 01/14/2025
	Plan of Correction
1 2 3 4	Administrator shall have the fire extingushier in facility before LPA visit is concluded. New extingushier inspected 01/13/2025.

Type A

Section Cited

CCR

87309(a)

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview the licensee did not comply with the section cited above. LPA Lewis observed the toxin in a closet unlocked which poses an immediate health, safety, or personal rights risk to persons in care.
	POC Due Date: 01/15/2025
	Plan of Correction
1 2 3 4	During today’s visit staff locked up the storage closet. Administrator will review the regulation cited and provide LPA Lewis a statement of acknowledgement by POC date 01/15/25 end of day 5:00 PM. Kesha.lewis@dss.ca.gov

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:

Liza King

LICENSING EVALUATOR NAME:

Kesha Lewis

LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025

LIC809 (FAS) - (06/04)

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