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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107207095
Report Date: 04/04/2022
Date Signed: 04/06/2022 07:53:52 AM


Document Has Been Signed on 04/06/2022 07:53 AM - 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 SELLAND HOMEFACILITY NUMBER:
107207095
ADMINISTRATOR:LUNA, NANCYFACILITY TYPE:
735
ADDRESS:6460 N. SELLAND HOMETELEPHONE:
(559) 269-4366
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY:6CENSUS: 3DATE:
04/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Art Real - House ManagerTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) D. Ayers arrived at facility unannounced to conduct a Required Annual visit and met with House Manager Art Real. Nancy Luna's administrator certificate was current with renewal date 05/19/2022.

Facility was clean, odor free, and at a comfortable temperature. Facility had sufficient furnishings inside and outside for resident use. Lighting was sufficient throughout facility. There was a sufficient supply of perishable and non-perishable foods and food is properly stored. All passageways and exits were clear and free from obstruction. Fire Extinguisher was serviced. Last fire drill was conducted on 3/18/2022. Smoke alarms and carbon monoxide detector were operational. LPA toured resident bedrooms and bathrooms. Bedrooms had required furnishings and bathrooms were clean and odor free. It was verified that there was at least one staff on duty who was CPR certified. Required postings were present. Medication and Medication Administration Record (MAR) was reviewed and medication appeared to be dispensed as prescribed.

No deficiencies were cited during the inspection. A copy of this report was provided to the licensee via email.

SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: David AyersTELEPHONE: (559) 650-7925
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2022
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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