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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209297
Report Date: 09/25/2023
Date Signed: 09/25/2023 11:39:50 AM


Document Has Been Signed on 09/25/2023 11:39 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
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: 26DATE:
09/25/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Jonathan Johnson, Licensee/AdministratorTIME COMPLETED:
12:00 PM
NARRATIVE
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On 9/25/23 at 11:05 AM, Licensing Program Analyst (LPA) Malia Thao conducted a case management visit to address deficiencies observed during the course of an investigation. LPA met with Licensee (LIC) Jonathan Johnson.

Specifically, during the course of an investigation, S1 made a false statement to the Department, initially reporting being unaware of an allegation related to a staff inappropriately touching a resident. When presented with text communication which showed that S1 was aware of the allegation, S1 acknowledged being aware and reported that S2 instructed S1 to lie to licensing about it.

Deficiencies are being cited in the attached LIC809D for violation of Title 22 regulations.

A copy of this report and appeal rights were provided to Licensee, 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: 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.

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


Document Has Been Signed on 09/25/2023 11:39 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
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)
Type A
09/26/2023
Section Cited
CCR
87207

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87207. No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility.
This requirement was not met as evidenced by:
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Licensee will submit an all staff in-service training and roster covering this regulation, to CCL by POC due date.
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***This requirement was not met when S1 made a false statement to the Department regarding a report of inappropriate touching of a resident. This poses an immediate health, safety and/or personal rights risk to residents in care.
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Type A
09/26/2023
Section Cited
HSC1569.58(a)(2)

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HSC 1569.58(a)(2) Conduct Inimical- (2) Engaged in conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility, or the people of the State of California.
This requirement was not met as evidenced by:
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Licensee will submit an all staff in-service training and roster covering this regulation, to CCL by POC due date.
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***This requirement was not met when S2 instructed S1 to lie to licensing about an allegation of inappropriate touching of a resident. This poses an immediate health, safety and/or personal rights risk to residents in care.
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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: Melinda HoffmannTELEPHONE: (559) -341-3274
LICENSING EVALUATOR NAME: Malia ThaoTELEPHONE: 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
LIC809 (FAS) - (06/04)
Page: 2 of 2