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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209297
Report Date: 04/24/2023
Date Signed: 04/24/2023 02:27:20 PM


Document Has Been Signed on 04/24/2023 02:27 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 ASSISTED LIVING/ WESTCHESTER GARDENSFACILITY NUMBER:
157209297
ADMINISTRATOR:JOHNSON, JONATHANFACILITY TYPE:
740
ADDRESS:2228 TRUXTUN AVETELEPHONE:
(661) 324-3091
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93301
CAPACITY:36CENSUS: 22DATE:
04/24/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Jonathan Johnson, AdministratorTIME COMPLETED:
01:00 PM
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On 4/24/23 at 8:55 AM, Licensing Program Analyst (LPA) Malia Thao arrived announced to conduct a Prelicensing inspection. LPA met with Licensee (LIC) Jonathan Johnson.

LPA toured the facility with LIC and Facility Manager Nicole Morehead. Residents were present during the inspection. No obstructions observed. Bedrooms have sufficient lighting. Grab bars observed for each toilet and shower. Facility was set at a comfortable position. Smoke and carbon monoxide combo detectors tested and operational. Three of five fire extinguishers observed last serviced on 5/26/22. Kitchen observed with dishes, utensils, and cook ware. Medication carts observed locked and stored in TV room. Chemicals observed in locked storage closet outside by laundry room. First aid kit observed complete.

The following observed needs to be brought into compliance:
1. Two out of five fire extinguishers observed without a service tag.
2. All toilets sampled, observed without a toilet seat. If toilet is shared, it must be installed with a toilet seat.
3. LPA observed multiple bathrooms with unclean floors behind the toilet.
4. LPA observed a sample of bathrooms with hot water measuring 101.5 degrees F in room #9, 101 degrees F in room #1, 124.1 degrees F in room #18, and 122.7 degrees F in room #16.
5. LPA observed room #16 without a non-skid mat.
6. Emergency lighting was not operational.
7. Sample of rooms observed without a chair.
8. Sample of rooms observed without toilet paper.
9. Facility does not have posting of facility's policy regarding theft and investigative procedures.
10. Copy of Admission Agreement not posted.
11. RCFE Complaint Poster (PUB 475) posted not in correct size.
12. Licensee's visiting policy is not posted.
13. Pre-appraisals not completed for new residents. --Continue on LIC809-C--
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -341-3274
LICENSING EVALUATOR NAME: Malia ThaoTELEPHONE: 559-470-9001
LICENSING EVALUATOR SIGNATURE:
DATE: 04/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/24/2023
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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: PATHWAY ASSISTED LIVING/ WESTCHESTER GARDENS
FACILITY NUMBER: 157209297
VISIT DATE: 04/24/2023
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Continued from LIC809.

Comp III completed. A follow up inspection to be scheduled once all above items are in compliance.

Exit interview conducted. A copy of this report was given to Licensee Jonathan Johnson, whose signature confirms receipt of this report.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -341-3274
LICENSING EVALUATOR NAME: Malia ThaoTELEPHONE: 559-470-9001
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023
LIC809 (FAS) - (06/04)
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