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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203969
Report Date: 06/13/2022
Date Signed: 06/13/2022 10:59:44 AM

Document Has Been Signed on 06/13/2022 10:59 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:NEW PATHWAYSFACILITY NUMBER:
157203969
ADMINISTRATOR:SEDAM, RUSSFACILITY TYPE:
775
ADDRESS:1107 OLIVE DR.TELEPHONE:
(661) 615-6480
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY: 60CENSUS: 20DATE:
06/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:46 AM
MET WITH:Program Manager, Priscilla ThomasTIME COMPLETED:
11:05 AM
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On 06/13/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Russ Sedam and Program Manager, Priscilla Thomas. The facility has one central entrance and exit. The facility has implemented a sign in policy for all clients, staff, and visitors.

LPA conducted a facility tour with Program Manager. The facility appeared clean with no fire clearance issues. Signs have been posted throughout the facility to promote hand-washing, cough/sneeze etiquette, and physical distancing. Hand sanitizer was readily available to clients, staff and visitors. Clients are placed in designated cohorts and staff interactions are limited to the staff assigned to the same cohort. The facility has a designated visitation room and isolation room. Hand-washing posters were observed by the bathroom sinks. Bathrooms were stocked with paper towels and liquid soap.

LPA observed an adequate supply of PPE and a 30 day supply of medications. Staff were observed to be wearing facial coverings. Client records have updated emergency contact information.

LPA is requesting the following documents be submitted to the Fresno CCL Office by 06/27/2022: Designation of Facility Responsibility, Administrative Organization, Affidavit Regarding Client Cash Resources, Emergency and Disaster Plan, Personnel Report, and current copy of the Administrator's certificate.

No deficiencies issued during today's inspection. Exit interview conducted. A copy of this report was discussed and provided to Program Manager, Priscilla Thomas, whose signature on this form confirms receiving this document.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2022
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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