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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209329
Report Date: 08/13/2024
Date Signed: 08/13/2024 12:06:38 PM

Document Has Been Signed on 08/13/2024 12:06 PM - 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/
DIRECTOR:
JOHNSON, JONATHANFACILITY TYPE:
735
ADDRESS:412 LANSING DRIVETELEPHONE:
(661) 972-4646
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 4CENSUS: 3DATE:
08/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:56 AM
MET WITH:House Manager Diana DiazTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On 08/13/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct required Annual inspection. LPA introduce self, stated the purpose of the visit, and met with House Manager Diana Diaz. Administrator Jaimy Johnson who stated unable to attend meeting. LPA toured facility with House Manager. All three residents observed during inspection.

The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. Medications and sharps observed kept locked in hall closet. An adequate supply of perishable and non-perishable food was observed. Fire extinguisher was observed with a service date of: 6/10/24. Last fire drill completed 08/09/24. Temperature maintained for refrigerator at 37 degrees F and freezer at 0 degrees F. All bedrooms were toured and observed to be required furniture and adequate lighting. Toilet observed functional and operational. Hot water temperature was tested 117.5 degrees F in bathroom 1 and 115.7 degrees F in shared bathroom. Chemicals were observed stored and locked under kitchen sink. Outside of facility toured and observed to be free of debris. Adequate outside seatings observed available for resident. Carbon monoxide and smoke detector observed operational during inspection.

No deficiency cited during visit.

Exit Interview conducted. A copy of this report was provided to House Manager, whose signature on this form confirms receipt of this report.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
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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