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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203492
Report Date: 10/09/2023
Date Signed: 10/09/2023 12:04:22 PM

Document Has Been Signed on 10/09/2023 12:04 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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:MOUNTAIN PATHWAYSFACILITY NUMBER:
157203492
ADMINISTRATOR:SOTO, AMYFACILITY TYPE:
775
ADDRESS:311 WEST F STREETTELEPHONE:
(661) 823-7302
CITY:TEHACHAPISTATE: CAZIP CODE:
93561
CAPACITY: 40CENSUS: 37DATE:
10/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Patti Valenzuela, Lead StaffTIME COMPLETED:
12:15 PM
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On 10/09/23, Licensing Program Analyst (LPA) M. Yang conducted required Annual Inspection. LPA introduced self, stated the purpose of the visit and requested to meet with Administrator. LPA met with Lead Staff Patti Valenzuela who stated Administrator Amy Soto was unable to attending meeting. Chief Administrative Officer (CAO) Melissa Stockton was called and stated both Administrator and CAO was unable to attend meeting. CAO authorized lead staff to sign and received report. There were 10 clients were present during the inspection.

All activity areas were clean and odor free. LPA toured facility and observed activity rooms: small, medium, big, kitchen, and isolation room. All passageways and exits were clear and free from obstruction. Fire extinguisher observed of serviced date: 07/12/22. Last fire drill completed on 09/27/23. Cleaning supplies were observed locked in supply room. Client locked lockers were observed. Client brings their own lunches. Clients’ foods were observed to be stored in refrigerator. All client’s restrooms were tour, observed to be clean, and operational. Hot water tested at 118 degrees F in laundry sink, 110.7 degree F in bathroom 1, 107.3 degrees F in bathroom 2, and 112.3 in bathroom 3. Outside was toured and observed to be free of obstruction. Outdoor seatings were observed available for clients. LPA observed locked medications in Program Manager office. MARs were reviewed. A sample of client files were also reviewed to have updated emergency contact information and physician report. Staff files have current CPR/ 1st Aid, good health screening, fingerprinted cleared and associated to facility.



No deficiencies were observed.

Exit Interview conducted. The following documents are requested and to be submitted to Fresno CCL by: 10/16/23. The following updated forms were requested: Lic 308, Lic 309 (if applicable), Lic 500, Lic 610D and admission agreement. A copy of this report was provided to the Lead staff, whose signature confirms receipt of this report.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 10/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2023
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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