<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425801528
Report Date: 03/17/2022
Date Signed: 03/17/2022 12:42:59 PM

Document Has Been Signed on 03/17/2022 12:42 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 LIFE LEARNING CTR LIFE CTR INDEPENDENCEFACILITY NUMBER:
425801528
ADMINISTRATOR:BRADLEE KIRKMANFACILITY TYPE:
775
ADDRESS:2450 PROFESSIONAL PKWYTELEPHONE:
(805) 934-3537
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY: 45CENSUS: 1DATE:
03/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Bradlee KirkmanTIME COMPLETED:
12:55 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 03/17/22 at 11:00 a.m., Licensing Program Analyst (LPA) Toan Luong conducted an unannounced One Year Infection Control Annual visit to the facility. LPA met with Administrator Bradlee Kirkman and explained the purpose of the visit.

LPA was screened at the entrance, and LPA toured the adult day program. At 11:45 a.m., LPA discussed items in the Infection Control Module and noted that all items were checked yes in the infection control domain. The building has multiple entrances. The back entrance had a sign to redirect clients and visitors towards the front entrance. The front has 2 entrances, one for the day program and another for administration. Day program clients will be redirected towards the day program central entry. Both entrances have the same type of screening process and signage posted. California Department of Social Services Provider Information Notices (CDSS PINs) were available to everyone in a binder at the entrance of the day program. LPA observed social distancing, cough etiquette, hand washing, and other good hygiene signs throughout the facility. Facility has had staff fit tested with N95. Infection Control module was addressed with Administrator to satisfaction.

LPA conducted exit interview with Administrator and emailed a copy of today's report and appeal rights to the Administrator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Toan Luong
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2022
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 1