157209297-9-25-2023-24-AS-MHON-CWPSJL-20231017135519

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157209297
Report Date: 09/25/2023
Date Signed: 09/25/2023 11:38:36 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/13/2023 and conducted by Evaluator Malia Thao

COMPLAINT CONTROL NUMBER: 24-AS-20230613143211

FACILITY NAME:	PATHWAY ASSISTED LIVING/ WESTCHESTER GARDENS		FACILITY NUMBER:	157209297
ADMINISTRATOR:	JOHNSON, JONATHAN		FACILITY TYPE:	740
ADDRESS:	2228 TRUXTUN AVE		TELEPHONE:	(661) 324-3091
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93301
CAPACITY:	36	CENSUS: 26	DATE:	09/25/2023
		UNANNOUNCED	TIME BEGAN:	10:46 AM
MET WITH:	Jonathan Johnson, Licensee/Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff inappropriately touched resident.
Staff not treating resident with respect.
Staff made inappropriate comments towards resident.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 9/25/23 at 10:46 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to deliver findings. LPA met with Licensee (LIC) Jonathan Johnson.

The Department investigated the allegations that staff inappropriately touched resident, staff do not treat resident with respect, and staff made inappropriate comments to resident. Based on interviews conducted, the preponderance of evidence standard has been met and the allegations are substantiated. While providing care to R1, S1 flicked R1’s genitals and S1 and S2 then laughed about it. During interviews, S1 admitted to on occasion, calling R1 “Old man” and telling R1 things like “You’re my big baby” and “You’re my love”, and S2 witnessed S1 on occasion, call R1 “Old man”. S1 and S2 stated that these things were said in a joking manner. Regardless of the reported intent, name calling and/or inappropriate statements represent a lack of respect for residents in care and are a violation of their personal rights.
Deficiencies cited in the attached LIC9099D, for violation of Title 22 regulations. Exit interview was conducted. A copy of this report and appeal rights were provided to Licensee, whose signature confirms receipt of this report.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) -341-3274
LICENSING EVALUATOR NAME: Malia Thao	TELEPHONE: 559-470-9001
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/13/2023 and conducted by Evaluator Malia Thao

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20230613143211

FACILITY NAME:	PATHWAY ASSISTED LIVING/ WESTCHESTER GARDENS		FACILITY NUMBER:	157209297
ADMINISTRATOR:	JOHNSON, JONATHAN		FACILITY TYPE:	740
ADDRESS:	2228 TRUXTUN AVE		TELEPHONE:	(661) 324-3091
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93301
CAPACITY:	36	CENSUS: 26	DATE:	09/25/2023
		UNANNOUNCED	TIME BEGAN:	10:46 AM
MET WITH:	Jonathan Johnson, Licensee/Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff forced resident to shower.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 9/25/23 at 10:46 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to deliver findings. LPA met with Licensee (LIC) Jonathan Johnson.

The Department investigated the allegation that staff forced resident to shower and based on interviews, there was not a preponderance of evidence to prove or disprove the allegation occurred therefore the allegation is unsubstantiated. No deficiencies cited.

Exit interview conducted. A copy of this report was given to Licensee, whose signature confirms receipt of this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) -341-3274
LICENSING EVALUATOR NAME: Malia Thao	TELEPHONE: 559-470-9001
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 24-AS-20230613143211

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/25/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed Type A 09/26/2023 Section Cited CCR 87468.1(a)(3)	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination.	1 2 3 4 5 6 7	Licensee will submit a written plan to include reaching out to Ombudsmen for training on resident personal rights, to include date of when in-service training for all staff including Licensee and Administrator will be scheduled and completed, and to include submission of in-service training to CCL immediately after completion, to CCL by POC due date.
	8 9 10 11 12 13 14	This requirement was not met when S1 flicked the genitals of R1 and S1 and S2 laughed about it. This poses an immediate health, safety and/or personal rights risk to residents in care.	8 9 10 11 12 13 14
Request Denied Type A 09/26/2023 Section Cited CCR 87468.1(a)(1)	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons.	1 2 3 4 5 6 7	Licensee will submit a written plan to include reaching out to Ombudsmen for training on resident personal rights, to include date of when in-service training for all staff including Licensee and Administrator will be scheduled and completed, and to include submission of in-service training to CCL immediately after completion, to CCL by POC due date.
	8 9 10 11 12 13 14	This requirement was not met when S1 called R1 “Old man” and made statements to R1 “You’re my big baby” and You’re my love”. This poses an immediate health, safety and/or personal rights risk to residents in care.	8 9 10 11 12 13 14

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: Melinda Hoffmann	TELEPHONE: (559) -341-3274
LICENSING EVALUATOR NAME: Malia Thao	TELEPHONE: 559-470-9001
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3