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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405800504
Report Date: 08/30/2022
Date Signed: 08/30/2022 03:59:57 PM

Document Has Been Signed on 08/30/2022 03:59 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:PATHPOINT LSP/CAS/EVRFACILITY NUMBER:
405800504
ADMINISTRATOR:LAUREN JOHNSONFACILITY TYPE:
775
ADDRESS:775 GRAND AVE STE C & DTELEPHONE:
(805) 473-9582
CITY:GROVER BEACHSTATE: CAZIP CODE:
93433
CAPACITY: 45CENSUS: 36DATE:
08/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Lauren JohnsonTIME COMPLETED:
04:05 PM
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Licensing Program Analyst (LPA) De Leon conducted an on site 1 year infection control annual visit to the facility above on 08/30/2022 at 2:20 PM. LPA met with Administrator Lauren Johnson and explained the purpose of the visit.

The Day Program is currently open to in person services. The program is running virtually 3 days a week and staff can drop off packets to clients homes if needed. LPA took a physical plant tour of the facility with staff. The facility has a check-in station set up at the front entry with masks, hand sanitizer, and thermometer. The facility has submitted a mitigation plan to the department and it has been approved. The entry point at the front door is the check-in point where everyone entering completes sign-in, symptom and temperature screening. All documentation will be kept on file. Signs are posted on the front door, entry area and walls in common areas regarding Covid-19. All staff are required to wear face masks when in the facility or on outings with clients in the community. Facility does have areas for visiting inside and outside. The facility will also offers virtual and telephone communications to all clients in care. Staff, clients and visitors will be informed of the facilities infection control policies. New staff and clients will be tested and negative results received before working or attending in-person services at the facility. The facility has procedures and plans for screening, isolation, testing, when to call 911 and notifying all responsible parties and agencies when needed. Emergency Disaster plan is posted and all agencies with telephone numbers are listed. Administrator is in charge of infection control and provides training and education to staff, clients and visitors.
Administrator is in charge of staffing and works on any issues or additional coverage if needed.
Continued 809-C
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: PATHPOINT LSP/CAS/EVR
FACILITY NUMBER: 405800504
VISIT DATE: 08/30/2022
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If any suspected or confirmed cases of Covid-19 are found with the clients, staff would isolate them in the isolation room and staff contact home for pick-up. Staff will use full PPE, N95 masks, face shields/or googles when dealing with any pending or confirmed cases of Covid-19. Facility is able to dedicate a room for client isolation. Enhanced precautionary signs are posted on isolation room and trash cans with tight fitting lids will be available for that room. Facility has plans for delivering medications and meals to isolation room if needed. The facility has proper cleaning and disinfectant sprays, EPA registered. Facility Administrator has a plan in place for when and whom to notify in an outbreak or other emergencies. Administrator will keep a line list of all vaccinated and tested staff/clients in care with dates/results. Facility has conducted training on infection prevention, symptoms, transmission and PPE use. Facility has non-punitive sick leave polices for staff. Sick staff are requested to stay home and not report to work if ill. Activities have been modified with social distancing. The facility ensures proper cleaning is done on all frequently touched surfaces and between any individuals sharing of space or items. Sinks will be stocked with soap, paper towels and hand washing signs. Client records are kept electronically on the computer. Staff records are kept in binders in the staff office. Facility does realize guidance changes and the most up to date guidance from CCL-PINS, CDC, CDPH, and local health departments should be followed to remain in compliance. Fire extinguishers were charged and inspected annually. Common areas have smoke detectors and a carbon monoxide detectors is present.

No deficiencies observed during the visit and all infection control protocols are being followed and implemented.

Exit interview completed and copy of report emailed to Administrator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022
LIC809 (FAS) - (06/04)
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