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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801840
Report Date: 11/09/2022
Date Signed: 11/09/2022 03:55:42 PM

Document Has Been Signed on 11/09/2022 03:55 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:PATHPOINTFACILITY NUMBER:
565801840
ADMINISTRATOR:WHITAKER, KIMFACILITY TYPE:
775
ADDRESS:501 MARIN ST STE 112TELEPHONE:
(805) 413-0790
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY: 45CENSUS: 45DATE:
11/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Denise AlamilloTIME COMPLETED:
03:05 PM
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Licensing Program Analyst (LPA) Ashley Smith arrived at the facility unannounced to conduct a required annual visit at 2:00 p.m. The LPA met with Denise Alamillo and explained the reason for the visit. There are fourteen (14) consumers and five (5) program staff present today.

The LPA toured the physical plant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

The program currently operates from 9:00 a.m. to 2:30 p.m. The day program is staffed with 1:4 staff to consumer ratios. The consumers are grouped into cohorts; there are approximately 20 participants in person per day to ensure adequate physical distancing and staffing. Temperatures of staff and consumers are taken upon entry into the facility.

Common Activity Space: The facility is a single-story structure with several activity rooms, a conference room, three bathrooms, offices, and a food service area. The LPA did not observe any obstructions or hazards. Activities: Activities are both designed for individual and as a group. The LPA observed staff working with consumers. Food Service: The kitchen area was clean and in good condition. Consumers bring their lunch and snacks. Restrooms: Restrooms were clean and sanitary. The LPA observed appropriate hand washing signs in the restroom. Water temperature measured at 105 degrees F at 2:10 p.m.

Infection Control: There was a central entry point for symptom screening and temperature checks. The LPA was appropriately screened upon entry. Staff and consumers were wearing appropriate face coverings. Infection Control signs were observed on the front door and throughout the facility. Facility has a sufficient supply of PPE but would like additional masks and gloves. The facility’s cleaning protocol was sufficient. There was record of staff and consumer vaccinations. The LPA discussed changes around testing, masking and vaccine requirements. The facility's 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: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2022
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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