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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425801528
Report Date: 03/22/2024
Date Signed: 03/22/2024 12:57:19 PM

Document Has Been Signed on 03/22/2024 12:57 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
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:PATHPOINT LIFE LEARNING CTR LIFE CTR INDEPENDENCEFACILITY NUMBER:
425801528
ADMINISTRATOR:BERENICE JAIMES-LEONFACILITY TYPE:
775
ADDRESS:2450 PROFESSIONAL PKWYTELEPHONE:
(805) 934-3537
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY: 45CENSUS: 15DATE:
03/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Berenice Jaimes-Leon, Administrator, Kellie Eaton, Program Manager, Lauren Johnson, Program Coordinator (On Call)TIME COMPLETED:
01:15 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 03/22/2024, Licensing Program Analyst (LPA) Brian Phillips arrived unannounced for an unscheduled visit to conduct a required Annual site inspection visit at the facility above. When the LPA arrived, they were greeted by Administrator Berenice Jaimes-Leon, Program Manager Kellie Eaton, On Call Staff/Program Coordinator Lauren Johnson, and informed them of the reason for the visit.

The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. This is an Adult Day Program (ADP), with an approved fire clearance capacity of Forty-Five (45) clients. The facility is approved for Fifteen (15) non-ambulatory clients. The physical plant of the facility has multiple entrances. There is a back entrance to the interior of the facility that has a sign to redirect clients and visitors towards the front entrance. The front of the facility has 2 entrances into the interior, one for the Adult Day Program Clients/Visitors and another for Administration/Staff Members. Clients of the Adult Day Program (ADP) are redirected towards the ADP central entry. Both entrances have the same type of screening process and signs/documentation posted. The ADP is the first floor of a two story building, with the 2nd story being strictly Staff member offices/areas and inaccessible to Day Program Clients. The ADP schedule is from 8:15am/8:30am-2:30pm Monday-Friday

FOOD PREPARATION AREA/KITCHEN: The facility is an Adult Day Program (ADP) and has a kitchen for clients of the facility. All food is selected, stored, prepared, and served in a safe and healthful manner. Snacks are available for all clients during the day from 6:30am-3:30pm Monday-Friday unless limited by physician dietary restrictions. Clients in care at the ADP for less than eight hours a day are provided meals and snacks so that no more than three and a half hours elapses between food service. Clients are also permitted to bring their own food to the Day Program. The ADP maintains equipment necessary for preparation of food in the facility and includes a dishwasher. The LPA inspected the food service area and observed that knives/sharp instruments are stored in locked drawers inaccessible to clients. All appliances were in operable condition and looked clean/in good repair. Continued on 809-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2024
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: PATHPOINT LIFE LEARNING CTR LIFE CTR INDEPENDENCE
FACILITY NUMBER: 425801528
VISIT DATE: 03/22/2024
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
26
27
28
29
30
31
32
The LPA observed perishable items in good condition, with proper expiration dates precluding the perishable items from expiring. The facility has a sufficient supply of perishable and non-perishable food. The hot water temperature was measured in the food service area at an appropriate temperature as per the regulation(s). The food service area was clean and sanitary, with covered trashcans and operating ventilation systems. No toxic substances are stored in any food preparation or storage area, and all cleaning supplies for the kitchen are kept in a separate area than the food supplies. The freezer and refrigerator were both in the appropriate temperate Fahrenheit for the storage of food and prevention of spoiling. There are enough utensils and food preparation items for all clients staying in the facility, and enough equipment for the storage, preparation, and service of food. There is enough tableware and utensils for all clients living in the facility, and enough equipment for the storage, preparation, and service of food. The Kitchen area has multiple cupboards that remain locked at all times due to various clients having issues with the theft of food from the kitchen. The kitchen contains a microwave, refrigerator/freezer, and stove area for the preparation of snacks during the Adult Day Program daily schedule.

COMMON AREAS: At the time of the visit, all common areas/interior rooms of the facility were observed to be appropriately furnished, with all furniture in good condition. The facility maintains a main entrance lobby with sign in materials as well as COVID screening procedures. The physical plant of the facility has multiple entrances. There is a back entrance to the interior of the facility that has a sign to redirect clients and visitors towards the front entrance. The front of the facility has 2 entrances into the interior, one for the Adult Day Program Clients/Visitors and another for Administration/Staff Members. Clients of the Adult Day Program (ADP) are redirected towards the ADP central entry. Both entrances have the same type of screening process and signs/documentation posted. The facility consists of the first floor of a two-story building, with the second story being strictly Staff member offices/areas and inaccessible to Day Program Clients. The facility has multiple Staff office rooms with desks, computers, storage cabinets, etc. on the second story. The facility common areas consist of a Media Room, Quiet Room, Sensory Room, Staff Office, Living Room, Storage Room, Meeting Room, Patio Outdoor Space, and client restrooms. There are no fireplaces on the premises. The facility maintained a comfortable temperature in all areas inspected. Activity materials are stored in various rooms in the facility and a locked storage area in the outdoor patio. The fire extinguishers in all buildings inspected were fully charged and were last serviced in 2024. The LPA observed required postings throughout all common spaces. There are activity supplies and equipment, including reading, game, and media materials for the clients in all common areas inspected. All window screens were in good repair in all the areas comprising the facility. Continued on 809-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: PATHPOINT LIFE LEARNING CTR LIFE CTR INDEPENDENCE
FACILITY NUMBER: 425801528
VISIT DATE: 03/22/2024
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
26
27
28
29
30
31
32
 There is appropriate lighting in all the common areas of the facility. All passageways through the common areas of the facility were free of obstruction, and all areas are well-lit. This facility is one (1) story throughout and therefore there are no stairways for clients to utilize. There is a main entrance walkway into the facility and an administrative entrance area for visitors. There is an electronic combination lock between the administrative entrance lobby area of the facility and the main interior. The facility has electronic locks on all doors that can exit the interior of the facility. The common areas of the facility are neat and clean. The facility maintains a comfortable temperature. Hallways, bedroom doors, and walls are in good repair.

RESTROOMS: There are Three (3) client restrooms in the facility. The facility restrooms were sanitized and in operating condition while the LPA toured the facility. All restrooms inspected were sufficiently stocked with soap, paper towels, and additional supplies; towels and washcloths are not shared. The hot water temperature was measured in the restrooms at the appropriate degrees Fahrenheit as per the regulations between 105-120 degrees Fahrenheit. Nightlights are not necessary in the hallways outside of the client restrooms as this is an Adult Day Program in which clients leave at 2:30pm Monday-Friday and are not present on the weekend (Saturday and Sunday). The client restrooms consist of a sink, toilet, storage areas for hygiene products/extra toiletries, and required postings.

RECORDS: The facility keeps confidential storage of both client and Staff member records on-site electronically at the facility. Staff member records were reviewed for, but not limited to Health Screening Report/Tuberculosis (TB) Clearance for facility personnel, Personnel Record (employment application), verification of age over 18 years old, education, and experience, approved Certification for the Administrator, verification of first aid training, Criminal Record Statement, Criminal Record Clearance/Exemption, Verification of Staff training, Employee Rights, and Abuse Reporting Requirements. All staff members’ personnel records reviewed by LPA had the appropriate documentation. Client records were reviewed for, but not limited to Pre-Admission/Placement appraisals, Client Appraisals/Individual Service Plan (ISP), Tri-Counties Regional Center Individual Program Plan (IPP), Physicians’ Report, Identification and Emergency Information, Current Admission Agreement with signatures, Personal Rights for Clients, Signed Consent Forms, Record of Clients safeguarded cash resources, Record of Client personal property/valuables, Self-management of medications if applicable, Medication Orders, and Medication Logs. All client records reviewed by the LPA had the appropriate documentation with no missing or incomplete information.

Continued on 809-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: PATHPOINT LIFE LEARNING CTR LIFE CTR INDEPENDENCE
FACILITY NUMBER: 425801528
VISIT DATE: 03/22/2024
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
26
27
28
29
30
31
32
MEDICATIONS: The facility maintains a locked centralized storage area for client medications. Centrally Stored Medications are in a locked storage containment area within the kitchen area of the facility. The medication cabinet remains locked at all times, inaccessible/locked to clients. As only one client in care at the ADP receives medication daily and is on vacation, there were no centrally stored medications observed by the LPA. LPA did observe the Centrally Stored Medication and Destruction Record, The Medication Administration Record, and the record of Controlled Medications. LPA audited the medications for clients and noticed no irregularities or issues concerning the dispensing of medications or the logging of medications. The medications in the facility were labeled appropriately with no additional or prohibited markings by the facility.

INFECTION CONTROL: Upon entry, the facility has a central entry point for symptom screening and a sanitation station. The staff members will keep up signs that promote good hand hygiene and symptoms of COVID. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate.

FACILITY DOCUMENTATION: There are required postings throughout the facility, including emergency exit plans with necessary telephone numbers. The facility keeps posted copies of facility documentation such as the License Certificate, LIC 500 Personnel Report, Documentation of Facility Waivers, Plan of Operation, Emergency Disaster Plan for Adult Facilities, Facility Infection Control Plan/Mitigation Plan, Certificate of Liability Insurance, Valid Administrator Certificate, and a Facility Sketch. Provider Information Notices are available and able to be presented to Staff, clients, visitors, and accessible to LPA upon request during the inspection process.

No deficiencies cited. Exit interview conducted. A copy of the report was issued to the facility.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4