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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209329
Report Date: 09/25/2024
Date Signed: 09/26/2024 11:10:41 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
09/04/2024 and conducted by Evaluator Mai Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240904090949
FACILITY NAME:PATHWAY HOME CAREFACILITY NUMBER:
157209329
ADMINISTRATOR:JOHNSON, JONATHANFACILITY TYPE:
735
ADDRESS:412 LANSING DRIVETELEPHONE:
(661) 735-3146
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY:4CENSUS: 4DATE:
09/25/2024
UNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Licensee Jason Johnson and Supervisor Diana DiazTIME COMPLETED:
11:25 AM
ALLEGATION(S):
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Staff did not prevent resident from eloping from facility
INVESTIGATION FINDINGS:
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On 09/25/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver finding on the above allegation. LPA was greeted by staff Melanie Zavala and granted entry. LPA introduce self and stated the purpose of the visit. Licensee Jason Johnson and Supervisor Diana Diaz arrived shortly.

During the course of the investigation, interviews were conducted, records were reviewed, and facility was toured. It was confirmed that C3 and C2 had AWOL from the facility on separate occasions.

Based on interviews which were conducted and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Exit interview conducted. A copy of this report and appeal rights was provided to Licensee.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024
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 4
Control Number 24-AS-20240904090949
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 HOME CARE
FACILITY NUMBER: 157209329
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/26/2024
Section Cited
CCR
80078(a)
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80078 (a) The licensee shall provide care and supervision as necessary to meet the client's needs.

This requirement is not met as evidenced by:
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Facility shall submit a written procedure for the prevention of potential future AWOLs. AWOL procedure to be submitted to Fresno CCL by 09/26/24.
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Based on interview and records review, the licensee did not provide care and supervision when C2 and C3 went AWOL which poses an immediate health and safety risks to persons 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.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4