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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209329
Report Date: 08/07/2023
Date Signed: 08/07/2023 10:18:48 AM

Document Has Been Signed on 08/07/2023 10:18 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 HOME CAREFACILITY NUMBER:
157209329
ADMINISTRATOR:JOHNSON, JONATHANFACILITY TYPE:
735
ADDRESS:412 LANSING DRIVETELEPHONE:
(661) 972-4646
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 4CENSUS: 0DATE:
08/07/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Licensee Jonathan Johnson and Supervisor Diana TIME COMPLETED:
10:30 AM
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On 08/07/23, Licensing Program Analyst (LPA) Yang arrived at the facility for an announced visit to conduct the Pre licensing visit. LPA Yang met with Licensee Jonathan Johnson and Supervisor Diana Diaz who granted LPA entry into the facility.

LPA toured the facility with Licensee and Supervisor. The facility is a 2 bedroom and 1 bathroom home and fire clearance was granted for 3 non-ambulatory and 1 bedridden for a total capacity of 4. The living room was clean and in good repair. There was seating available for clients.

LPA toured two bedrooms. Each bedroom had two beds, dresser, night stands, chair, required linens, working light, and enough space to accommodate people. Hot water temperature 112.3 degrees F in bathroom 1 and 110.1 in degrees F in bathroom 2. Both bathrooms were clean and in good repair. Both bathroom had nonskid strips in the shower with grab bars present in shower and next to the toilets.

Medications will be lock in hall closet. First aid kit was observed and contained all required items. Kitchen was toured and observed to have dishes, plates, and utensils.

A fire extinguisher was observed and with a purchased date of 08/09/23.

Chemicals was observed behind a locked door in the hallway and under kitchen sink. Outside of facility toured. Available outside seatings was observed for clients. LPA observed side gate to be self-latching.

Smoke detectors and carbon monoxide were observed to be operational during this inspection.

Facility phone number will be (661)735-3146.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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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 HOME CARE
FACILITY NUMBER: 157209329
VISIT DATE: 08/07/2023
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The following observed will need to be brought into compliance:

1. Bedroom 2 outlets keeps going out and not maintain operating during inspection.
2. Freezer temperature to be maintained at 0 degree F.
3. Refrigerator temperature to be maintained at 40 degrees F.
4. Thermostat displayed 79 degrees F. Licensee turn on the HVAC unit. Unit turned on blowing out air. The facility is still not maintained at a comfortable temperature.
5. Non-perishable food and perishable food are not available in the facility.
6. Fireplace shall be inaccessible to clients

A follow up inspection will be scheduled once all above items are in compliance.

An exit interview was conducted. A copy of this report and appeal rights was provided to Licensee, whose signature confirms receipt of this report.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023
LIC809 (FAS) - (06/04)
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