565801840-1-11-2022-29-AS-ASMH-CAKUUK-20220111145339

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565801840
Report Date: 01/11/2022
Date Signed: 01/11/2022 02:54:06 PM

Document Has Been Signed on 01/11/2022 02:54 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		FACILITY NUMBER:	565801840
ADMINISTRATOR:	WHITAKER, KIM		FACILITY TYPE:	775
ADDRESS:	501 MARIN ST STE 112		TELEPHONE:	(805) 413-0790
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY: 45		CENSUS: 48	DATE:	01/11/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Denise Alamillo		TIME COMPLETED:	03:00 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) Ashley Smith arrived at the facility unannounced to conduct a required annual visit at 1:40 p.m. This annual had a specific emphasis on infection control practices and procedures. The LPA met with Program Coordinator Denise Alamillo and explained the reason for the visit. There are fifteen (15) consumers and 4 program staff present today. At this time, the Day Program currently operates from 9:00 a.m. to 2:30 p.m. The day program is currently staffed appropriately with 1:4 staff to consumer ratios. The consumers are grouped into four cohorts; there are approximately 16 participants per cohort, and the consumers come to this location for in-person services two times a week to ensure adequate physical distancing and staffing. As such, as there are never more than forty-five (45) participants in the building at one time, the facility continues to operate within capacity as it pertains to the fire clearance. Consumers come to this location either via transportation or are dropped off by their responsible party. Staff take the temperatures and screen consumers prior to entering the building. The LPA toured the physical plant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Common Activity Space: The facility is a single-story structure with several activity rooms, one conference room, three bathrooms, staff offices, and a food service area. The LPA did not observe any obstructions or hazards. Equipment used for activities was in good condition at the time of the visit. Activities: Activities are both designed for individual and as a group. The LPA observed staff actively working with consumers. Food Service: The kitchen/food service area was clean and in good condition. There is a refrigerator which keeps consumer lunches cold. Consumers bring their own lunch and snacks. Restrooms: Restrooms were clean and trash cans have lids to protect consumers from cross contamination.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2022

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	FACILITY NUMBER: 565801840
	VISIT DATE: 01/11/2022

NARRATIVE

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Infection Control: During today’s visit, the LPA spoke with the Program Coordinator regarding the program’s infection control practices. Given the current circumstances as it relates to COVID-19, the facility has implemented the Pathpoint COVID-19 Safe Operations Guide, which is a regularly updated guide based on the latest guidance from federal, state and local authorities. The LPA obtained a copy of the Safe Operations Guide for the file.

Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. The LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The LPA observed hand sanitizer throughout the space for consumer and staff use. This facility has documented records of staff vaccinations. The LPA observed appropriate signs throughout the space that promoted good hand hygiene, signs and symptoms of COVID-19, droplet precautions, and proper mask usage. The facility’s cleaning protocol is sufficient. The facility’s policies and procedures as it pertains to infection control are adequate.

No deficiencies were cited at this time. Exit interview conducted. A copy of the report was provided.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2022

LIC809 (FAS) - (06/04)

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