425801528-2-13-2023-29-AS-RDLN-CNZTVQ-20230213140420

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 425801528
Report Date: 02/13/2023
Date Signed: 02/13/2023 02:04:29 PM

Document Has Been Signed on 02/13/2023 02:04 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 INDEPENDENCE		FACILITY NUMBER:	425801528
ADMINISTRATOR:	BRADLEE KIRKMAN		FACILITY TYPE:	775
ADDRESS:	2450 PROFESSIONAL PKWY		TELEPHONE:	(805) 934-3537
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93455
CAPACITY: 45		CENSUS: 13	DATE:	02/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Valerie Ybarra, Back up to Administrator		TIME COMPLETED:	02:12 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	Licensing Program Analyst (LPA) De Leon conducted a 1 year infection control Annual visit to the facility above. LPA met with Valerie Ybarra, back up to Administrator and explained the purpose of the visit. LPA took a physical plant tour of the facility with staff. The Adult Day Program (ADP) has submitted a mitigation plan and Infection control plan to the department. The ADP has a central entry point for staff to sign in and symptoms screen as well as a separate entry for ADP clients. Routine symptom screening is being preformed on client in care and anyone showing any signs or symptoms is taken to the isolation room for pickup from the program. Signs are posted at entrance and in the common areas of the facility regarding Covid-19. Hand Sanitizer is available on entry, the facility has 3 bathrooms with plenty of soap, paper towels, toilet paper and hand washing signs. Facility had procedures for testing staff and or clients in care when needed. Facility has a separate isolation room for any client that is not feeling well or displaying symptoms. Trash bins and waste baskets have tight fitting covers. Facility has 30+ days of PPE supplies. Facility staff wear masks at the facility and when on outings with clients. Facility staff will wear full PPE with N95 masks and face shields when dealing with any pending or confirmed cases of Covid-19. Facility will keep a line list of all staff/clients testing and vaccinations. Facility staff have non-punitive sick leave policies and ill staff are requested to stay home and not report to work if they are ill. Continued 809-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

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 LIFE LEARNING CTR LIFE CTR INDEPENDENCE	FACILITY NUMBER: 425801528
	VISIT DATE: 02/13/2023

NARRATIVE

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Facility has developed policies for Covid-19 precautions. PPE supplies are stored in storage room accessible to staff working. All emergency contact information has been updated on all clients in care. Facility audits supplies and replenishes when low.Administrator has a plan in place for back-up staffing when and if needed. The facility keeps records of client illnesses and reports to the clients responsible party and CCL when required. All clients in care have the right to reject medical services. The facility keeps staff on duty who is trained and competent to handle and deal with emergency personnel. The facility has an emergency plan posted with contact phone numbers for doctors, dentists, police, fire, ambulance and paramedics. The facility provides a safe and healthy in door activity space for clients in care. Staff and resident records are kept in 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. The most stringent orders should be followed by any of these agencies. The facility fire extinguishers were last inspected on 02/15/2022. Smoke and carbon monoxide detectors are present. The facility kitchen is not in use at this time. Clients attend 1 of the programs AM or PM time slots therefore lunch is not being served at the program. The facility is clean, safe and sanitary.

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

Exit interview completed and copy of report printed for Administrator.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

LIC809 (FAS) - (06/04)

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