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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209217
Report Date: 08/18/2026
Date Signed: 08/18/2026 01:54:58 PM

Document Has Been Signed on 08/18/2026 01:54 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:PATHWAY HOMESFACILITY NUMBER:
157209217
ADMINISTRATOR/
DIRECTOR:		JOHNSON, JAIMYFACILITY TYPE:
740
ADDRESS:334 MONTCLAIR STTELEPHONE:
(661) 972-6051
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 4CENSUS: 3DATE:
08/18/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Administrator Diana DiazTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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On 08/18/2026, Licensing Program Analysts (LPA) J. Duarte and M. Vega arrived unannounced to conduct the required Annual inspection. LPAs introduced selves, stated the purpose of the visit, and met with staff. Staff contacted Administrator (AD) Diana Diaz and she arrived shortly after. LPAs toured the facility with AD. Staff stated that there are three residents; one resident is in the facility, one resident is in the hospital, and one resident is at the clinic.

The facility was observed to be at a temperature of 73 degrees F, clean, in good repair, and no passageway obstructions were observed. The living room had sufficient seating for residents. The kitchen was toured and LPA observed a two day supply of perishable and seven day supply non-perishable food. The facility stores sharps in a locked kitchen cabinet. Chemicals were observed stored and locked in the cabinet under the kitchen sink. A fire extinguisher was observed in the kitchen, with a service date of 05/28/26. The dining room has a fireplace with a cover.

Bedrooms were toured and observed to have the required furniture and adequate lighting. Bathrooms were observed operational, with non-skid strips and grabbed bars were observed. The hallway restroom hot water measured at 110 degrees F and the hot water to the restroom connected to the room measured at 111 degrees F. Based on observation, three out of four oxygen tanks in a resident room were not secured in a stand or to the wall.

The facility has a dryer and washer in the hallway. Extra linens and towels observed stored in a hall closet.

The back patio was toured and observed to be free of debris with adequate seating available for residents. The back back patio has a self latching gate.

Continued in LIC 809C.

Alexandria Walton
Jimmy Duarte
DATE: 08/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2026
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 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: PATHWAY HOMES
FACILITY NUMBER: 157209217
VISIT DATE: 08/18/2026
NARRATIVE
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Continued from LIC 809.

The carbon monoxide/smoke detector was observed operational during inspection. Medications observed kept locked in a hallway closet. A first aid kit is also stored in the medication closet. All resident files and a sample staff files were reviewed and observed to have required documentation. On 08/05/2026, per staff, R1 was sent to the hospital due to sustaining an injury. There is no record of the facility reporting the incident to CCLD. Medications and MAR log were reviewed. Based on observation, one resident had PRN medication transferred and pre-dispensed into a different container other than its originally received container that does not have the pharmacist label.

Deficiencies are being cited on the attached LIC 809D pages, in accordance to California Code of Regulations, Title 22.

An exit Interview was conducted. A copy of this report and appeal rights were emailed to AD.

Residential Care Facility for the Elderly (RCFE):

· LIC 308 Designation of Facility Responsibility


· -as applicable: LIC 309 Administrative Organization
· -as applicable: LIC 400 Affidavit Regarding Client/Resident Cash Resources
· -as applicable: LIC 402 Surety Bond
· LIC 500 Personnel Report
· LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly
· LIC 9020 Register of Facility Clients/Residents
· Copy of current Liability Insurance
· Copy of current Administrator Certificate
· Alternate contact information including name, telephone number, & email address.

Please submit the above forms/information to Fresno CCL by: 08/25/2026.

NAME OF LICENSING PROGRAM MANAGER: Alexandria Walton
NAME OF LICENSING PROGRAM ANALYST: Jimmy Duarte
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 08/18/2026 01:54 PM - It Cannot Be Edited


Created By: Jimmy Duarte On 08/18/2026 at 01:05 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: PATHWAY HOMES
FACILITY NUMBER: 157209217

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/18/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87211(a)(1)
Reporting Requirements
(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interviews, R1 was sent to the hospital due to sustaining an injury and there is no record of the facility reporting the incident to CCLD, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/25/2026
Plan of Correction
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Administrator stated that regulation on reporting requirements will be reviewed, and implement a process to ensure incident reports are submitted to CCLD. Documentation of the process will be submitted to CCLD by POC due date of 08/25/2026
Type B
Section Cited
CCR
87465(h)(5)
Incidental Medical and Dental Care Services
(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, one resident had PRN medication transferred and pre-dispensed into a different container other than its originally received container that does not have the pharmacist label, which poses/posed a potential health, safety or personal rights risk to persons in care.which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/25/2026
Plan of Correction
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Administrator stated that a medication procedure will be submitted to CCLD to be reviewed for approval.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Alexandria Walton
NAME OF LICENSING PROGRAM MANAGER:
Jimmy Duarte
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/18/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2026


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 08/18/2026 01:54 PM - It Cannot Be Edited


Created By: Jimmy Duarte On 08/18/2026 at 01:05 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: PATHWAY HOMES
FACILITY NUMBER: 157209217

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/18/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87618(b)(3)(E)
Oxygen Administration - Gas and Liquid
(3) Ensuring that the use of oxygen equipment meets the following requirements: (E) Oxygen tanks that are not portable shall be secured in a stand or to the wall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, three out of four oxygen tanks in a resident's room were not secured in a stand or to the wall, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/01/2026
Plan of Correction
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Administrator stated that a stand will be purchased to secure oxygen tanks and will provide proof/photos to CCLD by POC due date of 09/01/2026
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Alexandria Walton
NAME OF LICENSING PROGRAM MANAGER:
Jimmy Duarte
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/18/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2026


LIC809 (FAS) - (06/04)
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