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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209329
Report Date: 01/09/2025
Date Signed: 01/09/2025 12:18:47 PM

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
12/02/2024 and conducted by Evaluator Mai Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20241202160513
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: 2DATE:
01/09/2025
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Diana Diaz, House SupervisorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff did not seek medical attention for resident in care in a timely manner
INVESTIGATION FINDINGS:
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On 01/08/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to delivered complaint findings on the above allegation. LPA introduced self, stated the purpose of the visit and requested to met with Administrator. Licensee Jason Johnson was called and stated unable to attend meeting. Licensee authorized House Supervisor Diana Diaz to recieved and sign report. House Supervior arrived shortly. LPA met with House Supervisor.

During the course of the investigation, records were received, interviews were conducted, and facility was toured. R1 was found unresponsive inside the facility, staff did not seek medical attention. Based on interviews conducted and records received, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 6 are being cited on the attached LIC 9099D. An exit interview was conducted. A copy of this report and appeal rights was provided to the House Supervisor, whose signature on this form confirms receipt of this report.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025
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
Control Number 24-AS-20241202160513
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: 01/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/10/2025
Section Cited
CCR
80075(a)
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80075(a) The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services, including arrangement for and/or provision of transportation to the nearest available services.

This requirement was not met as evidenced by:
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Licensee shall submit a written statement detailing the steps the facility will take to ensure the requirements for section 80075 are met to the Fresno CCL office by the POC due date 01/10/25.
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Based on interviews conducted and records received, when R1 was found unresponsive in the facility, staff did not seek medical attention 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: 01/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3