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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206784
Report Date: 10/29/2024
Date Signed: 10/29/2024 02:08:44 PM

Document Has Been Signed on 10/29/2024 02:08 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:PATHWAY HOMESFACILITY NUMBER:
157206784
ADMINISTRATOR/
DIRECTOR:		JOHNSON, JASONFACILITY TYPE:
735
ADDRESS:15923 SAN MARCO PLACETELEPHONE:
(661) 302-4825
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 6CENSUS: 6DATE:
10/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:28 AM
MET WITH:Administrator, Jason Johnson and Assistant Administrator, Diana DiazTIME VISIT/
INSPECTION COMPLETED:
02:22 PM
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On 10/29/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA was granted entry to the facility and facility staff contacted Administrator via telephone. LPA met with Administrator, Jason Johnson and Assistant Administrator, Diana Diaz.

LPA reviewed client and staff files. Upon review of staff files, LPA did not observe updated training for 2 out of 3 staff. LPA will return at a later date to issue a citation, if needed. Emergency disaster plan was reviewed verbally with Administrator. Per facility records, the last fire drill was conducted on 10/22/2024. LPA reviewed client medications. Medications observed to be locked and inaccessible to clients in care.

Facility tour conducted with Assistant Administrator. All exits were open and free from obstructions. Common areas were furnished with adequate lighting. Facility kitchen toured and observed to be clean and safe for food preparation. LPA observed an adequate supply of food. Knives observed to be locked and inaccessible to clients in care. Facility bathroom toured. Bathroom observed to be operational. Hot water measured at 110.8 degrees F. Resident bedrooms toured and observed to have required furnishings and adequate lighting. Cleaning supplies observed to be locked and inaccessible in a hallway closet. Smoke detector and carbon monoxide detector were operational during today's inspection.

No deficiencies issued during today's inspection.

Exit interview conducted. During the exit interview, LPA requested for the facility to develop a procedure to track medication refill requests to ensure that all clients receive their medications as prescribed. A copy of this report was discussed and provided to Administrator, Diana Diaz, whose signature on this form confirms receipt of this document.

LPA is requesting the following documents be submitted to the Fresno CCL office by 11/12/2024: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400),Emergency and Disaster Plan (LIC610D), Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020), Surety Bond, and an updated Facility Sketch.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
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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