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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206836
Report Date: 06/27/2024
Date Signed: 06/27/2024 01:34:04 PM

Document Has Been Signed on 06/27/2024 01:34 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, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:PATHWAYS ADLER HOMEFACILITY NUMBER:
107206836
ADMINISTRATOR/
DIRECTOR:		JOHNSON, D. MAEFACILITY TYPE:
735
ADDRESS:130 ADLER AVE.TELEPHONE:
(559) 325-3528
CITY:CLOVISSTATE: CAZIP CODE:
93612
CAPACITY: 4CENSUS: 4DATE:
06/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:12 AM
MET WITH:Staff Laura Ramero and House Manager ShalonTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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Licensing Program Analyst Shawna Doucette (LPA) arrived at the facility unannounced to conduct a Required Annual inspection. LPA contacted the House Manager Shalon Bowie via telephone who advised Staff Laura Romero would respond to assist with the visit. House Manager Shalon Bowie also responded to the facility to assist with the visit.

LPA conducted a tour inside and outside of facility with Staff Laura Romero. Facility observed to be clean, and at a comfortable temperature. Common areas were furnished well with adequate seating and lighting available. Kitchen toured, appeared clean and safe for food preparation. Food supply checked, LPA observed an adequate supply of food. Resident rooms checked. LPA observed an adequate supply of linen. Hot water measured at 112.6 degrees F. Facility was set at 75 F. Exterior tour conducted, all exits open and free of obstructions. Side gate was observed to be self-latching.

Fire extinguisher serviced on 03/11/2024. Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. Last fire drill conducted 03/17/2024. Medications were locked in a kitchen closet in a toolbox. All cleaning supplies are locked and secured in a closet in the kitchen.

LPA reviewed staff and resident records. LPA reviewed medications and logs.

An exit interview was conducted with Staff Laura Romero and a copy of this report was provided.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2024
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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