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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209133
Report Date: 09/27/2023
Date Signed: 09/28/2023 09:08:12 AM


Document Has Been Signed on 09/28/2023 09:08 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:PATHWAY HOMESFACILITY NUMBER:
157209133
ADMINISTRATOR:JOHNSON, JASONFACILITY TYPE:
740
ADDRESS:2714 GOSFORD RD #ATELEPHONE:
(661) 972-6235
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY:6CENSUS: 5DATE:
09/27/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Administrator Jason JohnsonTIME COMPLETED:
04:07 PM
NARRATIVE
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Licensing Program Analyst (LPA) Darius Williams conducted an unannounced visit to the facility. LPA Williams met with Administrator Jason Johnson and discussed the purpose of the visit.

LPA Williams reviewed resident files. Resident 1 and Resident 2 have restricted health conditions. LPA Williams interviewed the Administrator and reviewed employee files. LPA Williams did not observe any training records conducted by a licensed skilled profession, in the file, pertaining to general or specific procedures regarding R1 and R2's Restricted Health Condition.

Administrator reported prior staff may have received training. Administrator reported he is going to partner with R1 and R2 primary care physicians or Home Health Agency to assist with training.

Based on record review and interview, a deficiency is being cited on the attached LIC 809D page.

POC was discussed with Administrator.

An exit interview was conducted and a copy of this report will be provided via e-mail.
SUPERVISOR'S NAME: Serigy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius WilliamsTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 09/28/2023 09:08 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710


FACILITY NAME: PATHWAY HOMES
FACILITY NUMBER: 157209133

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/06/2023
Section Cited
CCR
87613(a)(2)

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(a)Prior to admission of a resident with a restricted health condition, the licensee shall:
(2) Ensure that facility... complete training provided by a licensed professional sufficient to meet those needs.

This requirement was not met evident by:
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Licensee agreed to reach out to licensed skill professional to train staff who provide care to R1 and R2, in regards to their Restricted Health Conditions. Licensee will provide training to the Department by POC due date of 10/6/2023.
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Based on record review and interview the Licensee did not ensure staff had general and specific Restricted Health Condition
training for 2 of 5 residents, which poses a potential health and safety risk for persons in care.
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LPA Williams also disucssed the Technical Support Program reference guide and Title 22 regulations with the Licensee.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Serigy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius WilliamsTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2023
LIC809 (FAS) - (06/04)
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