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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209216
Report Date: 12/22/2023
Date Signed: 12/28/2023 08:57:46 AM


Document Has Been Signed on 12/28/2023 08:57 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:
157209216
ADMINISTRATOR:JOHNSON, JAIMYFACILITY TYPE:
740
ADDRESS:336 MONTCLAIR STTELEPHONE:
(661) 972-6051
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY:4CENSUS: 3DATE:
12/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator, Jason JohnsonTIME COMPLETED:
02:04 PM
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Licensing Program Analyst (LPA) Darius Williams conducted an annual inspection visit. LPA met with Administrator, Jason Johnson and discussed the purpose of the visit.

LPA Williams toured the facility with the Administrator.

LPA observed the living room to have seating available for four residents and space to move around. Facility thermometer reflected 73 degrees Fahrenheit (F).

LPA observed two bedrooms. Rooms had space for residents to move around. The rooms had a bed with required linens, chair, night stand, and dresser.

Two bathrooms had grab bars and slip resistant strips placed in the bathroom/shower floor.

The kitchen was clean and in good repair. LPA observed 2 days of perishable food and seven days of non perishable food. Kitchen refrigerator reflected approximately 41 degrees Fahrenheit (F) and the freezer -2 degress F.

Chemicals and medications were observed locked and inaccessible to residents.

LPA observed smoke detectors to be present and operational.

First aid kit was present with all required items.

*Continued on LIC 809C*
SUPERVISOR'S NAME: Serigy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius WilliamsTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 12/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/22/2023
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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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: 157209216
VISIT DATE: 12/22/2023
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The backyard had seating and space to accommodate residents. There is no pool on the premises.

LPA reviewed 3 resident files and 3 employee files, which had all items requested.

No deficiencies were cited during the visit.

An exit interview was conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Serigy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius WilliamsTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023
LIC809 (FAS) - (06/04)
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