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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157200680
Report Date: 06/26/2023
Date Signed: 06/26/2023 01:54:37 PM

Document Has Been Signed on 06/26/2023 01:54 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, 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: 61DATE:
06/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:13 AM
MET WITH:Irais MejiaTIME COMPLETED:
02:27 PM
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Licensing Program Analyst (LPA) Katie Brown arrived at the Day Program unannounced to conduct the Annual Inspection. LPA met with and explained the purpose of the visit with Program Manager (PM) Irais Mejia.

During this visit, LPA toured the Day Program inside and out with Program Manager (PM) Irais Mejia. Program Participants were observed participating in group activities and having lunch together with assigned instructors providing care and supervision. LPA observed hand washing signs as well as required items in client restrooms. Client medication was locked and stored in the med room. Medication and Centrally Stored logs were reviewed. The day program grounds are clean and in good repair. Disinfectants and cleaning supplies were locked and inaccessible to clients. Emergency procedures are in place, PPE is available if needed. Outside was toured, seating and shaded areas are available. Doors and passageways are unobstructed throughout the program. Fire Extinguishers dated 2/7/23. Smoke and Carbon Monoxide detectors present and in working order. LPA conducted client and staff file reviews and interviews.

There were no citations issued during this inspection.

An exit interview was conducted and a copy of this report was left with PM, whose signature on this form confirms receipt.

LPA requested the following updated forms faxed to CCLD by 7/5/23: Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Affidavit Regarding Client/Resident Cash Resources (LIC 400), Surety Bond (Lic402), Emergency Disaster Plan LIC610E, Personnel Report (LIC 500), Client Roster (LIC 9020), Proof of current Liability Coverage.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2023
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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