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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157200680
Report Date: 06/23/2022
Date Signed: 06/23/2022 12:14:35 PM

Document Has Been Signed on 06/23/2022 12:14 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:PATHWAYSFACILITY NUMBER:
157200680
ADMINISTRATOR:STOCKTON, JOHNFACILITY TYPE:
775
ADDRESS:1401 POSO AVENUETELEPHONE:
(661) 758-5331
CITY:WASCOSTATE: CAZIP CODE:
93280
CAPACITY: 90CENSUS: 31DATE:
06/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:59 AM
MET WITH:Program Manager Irais Mejia TIME COMPLETED:
12:20 PM
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On 06/23/2022, Licensing Program Analyst (LPA) K.Kaur arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit, and met Program Manager Irais Mejia and lead staff Maria Gomez. No clients were present during the inspection due to facility closing down after COVID outbreak from 6/13/2022 to 6/24/2022.

Visitor log-in/temperature check was observed upon entry. Staff observed with facial coverings. Hand sanitizer
was readily available to clients and visitors. Fire extinguishers were present and have been serviced. Hand washing and other various Covid-19 related signs were observed in the common areas.

LPA toured the facility inside and outside. All passageways and exits were clear and free from obstruction.
Facility was at a comfortable temperature and well lit. All classrooms and activity areas were clean and odor
free. Bathrooms were clean and fixtures were functioning properly. LPA observed multiple first-aid kits
throughout the facility.

Facility dining area toured and appeared clean and is being used an open classroom to follow social distancing guidelines. Clients bring their own lunches to program. Lunches stored in refrigerator in facility kitchen. LPA observed 30-day PPE supply outside of the isolation room. A sample of staff and client files were reviewed.

No deficiencies were observed.

An exit interview was conducted. The following documents are requested and need to be submitted to Fresno CCL by 6/30/22. Designation of Facility Responsibility LIC308, Administrator Organization LIC309, Personnel Report LIC500, Emergency and Disaster Plan LIC610D, and Register of Facility Clients LIC9020. Report signed on-site by Manager and a printed copy was provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
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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