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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209329
Report Date: 07/25/2024
Date Signed: 07/25/2024 02:55:30 PM

Document Has Been Signed on 07/25/2024 02:55 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
CCLD Regional Office, 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:
07/25/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:House Manager, Diana DiazTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Darius Williams conducted an unannounced visit at the facility.

LPA D. Williams observed Resident 1 in their bedroom sitting on a wheelchair. R1's wheelchair has an extension that keeps their legs propped up horizontal to the ground. R1 has use of there arms and is able to use their wheel chair to move around.

LPA Williams asked R1 to exit the bedroom and they were unable. At the time there was not enough room for the wheel chair to line up with the threshold of the door due to bed placement. R1 attempted to exit the room at an angle, however the wheel chair is longer than average which made it difficult for R1 to navigate. R1's right wheel was unable to clear the doorframe.

According to R1 and House Manager, a hoyer lift is used to assist R1 out of their room.

Based on observation R1 is unable to comfortably exit the bedroom with their wheelchair. A deficiency is being cited on the attached LIC 809D page.

House Manager reported a consult with R1's doctor/insurance for other possible and/or modifications for client-assistive device or explore other options to maximize R1's independence.

Plan of correction was reviewed and discussed.

An exit interview was conducted and a copy of this report and appeal rights were provided via e-mail.
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2024
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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Document Has Been Signed on 07/25/2024 02:55 PM - It Cannot Be Edited


Created By: Darius Williams On 07/25/2024 at 12:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: PATHWAY HOME CARE
FACILITY NUMBER: 157209329

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2024
Section Cited
CCR
85087(a)(2)

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(2) Bedrooms must be large enough to allow for easy passage and comfortable use of any required client-assistive devices, including but not limited to wheelchairs...

This requirement was not met evident by:
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House Manager agreed to discuss options with doctor/insurance, ask if R1 wants to willingly transfer to a facility owned by Licensee, or conduct a new appraisal and if not can not be met, relocate. Documents wil be provided to the Department by POC due date 7/31/2024.
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Based on LPA observation the licensee did not ensure Resident 1's wheelchair was able to exit their bedroom, which poses a potential health and safety risk 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.
SUPERVISOR'S NAME:Serigy Pidgirny
LICENSING EVALUATOR NAME:Darius Williams
LICENSING EVALUATOR SIGNATURE:
DATE: 07/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2024


LIC809 (FAS) - (06/04)
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