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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209308
Report Date: 01/04/2024
Date Signed: 01/04/2024 12:42:38 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/30/2023 and conducted by Evaluator Darius Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20231130085456
FACILITY NAME:PATHWAY HOME CAREFACILITY NUMBER:
157209308
ADMINISTRATOR:JOHNSON, JONATHANFACILITY TYPE:
740
ADDRESS:414 LANSING DRIVETELEPHONE:
(661) 972-4646
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY:4CENSUS: 4DATE:
01/04/2024
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:House Manager, Diana Diaz and Liz RamosTIME COMPLETED:
12:41 PM
ALLEGATION(S):
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Facility is refusing to accept a resident back after hospitalization.
Facility did not effectively communicate with a resident's medical provider.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Darius Williams conducted an unannounced follow up visit. LPA met with House Manager Diana Diaz, House Manager Liz Ramos, and discussed the purpose of the visit.

LPA has conducted interviews and record reviews.

Facility provided an order to the LPA fromResident 1’s (R1) physician stating a Skilled Nursing Facility (SNF) was needed. The Administrator and Staff 1(S1) reported they informed the hospital regarding the physicians order, but did not provide the note nor did the hospital request the note.

On 12/4/2023, Hospital Worker 1 (HW1) reported they were going to place R1 into a Skilled Nursing Facility; at this the hospital was not in possession of the physician order for a SNF. LPA requested additional info which was not provided.

*Continued on LIC 9099-C*
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
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 2
Control Number 24-AS-20231130085456
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: PATHWAY HOME CARE
FACILITY NUMBER: 157209308
VISIT DATE: 01/04/2024
NARRATIVE
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On 12/12/2023, LPA Williams attempted to reach out to HW1 again for clarification via phone and e-mail with no success.

In regards to the allegation, facility did not effectively communicate with a resident's medical provider,according to HW1, on 11/28/2023 a nurse contacted the facility and spoke to (S1). S1 verified speaking to a nurse from the hospital.

HW1 reported attempting to contact the facility at the following number, 661-972-6468, which is a phone number to an individual not associated to the facility. HW 1 reported attempting to contact the facility through phone numbers found online with no success.

The Administrator reported on 12/7/2023, that he reached out to the hospital and reported R1 is being placed into a SNF.


Although the allegations, facility is refusing to accept a resident back after hospitalization and facility did not effectively communicate with a resident's medical provider. may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted and a copy of this report will be provided via e-mail.
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2