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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208994
Report Date: 10/15/2024
Date Signed: 10/15/2024 01:15:07 PM


Document Has Been Signed on 10/15/2024 01:15 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:PATHWAY HOMESFACILITY NUMBER:
157208994
ADMINISTRATOR:JOHNSON, JASONFACILITY TYPE:
740
ADDRESS:2714 GOSFORD RD #CTELEPHONE:
(661) 302-4728
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY:6CENSUS: 5DATE:
10/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Licensee/ Administrator Jason Johnson and Program Director Diana DiazTIME COMPLETED:
01:30 PM
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On 10/15/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct required Annual
inspection. LPA introduce self, stated the purpose of the visit, and was greeted by Licensee/ Administrator Jason Johnson and Program Director Diana Diaz. LPA toured facility with Licensee and Program Director. Four residents observed during inspection. Licensee left during inspection.

The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. An adequate supply of perishable and non-perishable food was observed. Fire extinguisher was observed with a service date of: 06/10/24. Temperature maintained for refrigerator at 35 degrees F and freezer at -2 degrees F. Medications observed locked in hall closet. All bedrooms were toured and observed to be required furniture and adequate lighting.
Bathrooms were toured. Toilet observed functional and operational. Non-skid strips and grabbed bars were observed. Hot water temperature was tested 116.5 degrees F in hall bathroom and 106.3 degrees F
in shared bathroom. Outside of facility toured and observed to be free of debris. Carbon monoxide and smoke detector observed operational during inspection.

No deficiency cited during visit.

Exit Interview conducted. The following documents requested to be updated and submitted to Fresno
CCL by 10/21/24: Lic 308, Lic 500, Lic 610E, current Administrator certificate, and current liability insurance. A copy of this report was provided to Program Director, whose signature on this form confirms receipt of this report.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/15/2024
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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