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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209435
Report Date: 12/30/2024
Date Signed: 12/30/2024 10:49:50 AM

Document Has Been Signed on 12/30/2024 10:49 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 HOMESFACILITY NUMBER:
157209435
ADMINISTRATOR/
DIRECTOR:		JOHNSON, JAIMYFACILITY TYPE:
735
ADDRESS:330 S MONTCLAIR STTELEPHONE:
(661) 972-6051
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 4CENSUS: 0DATE:
12/30/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Licensee Jason Johnson via telephone and Assistant Administrator Diana DiazTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On 12/30/24, Licensing Program Analysts (LPA) M. Yang conducted an announced Pre-licensing / Component III Inspection. LPA introduced self, stated the purpose of the visit and was allowed entry into the facility. LPA met with Assistant Administrator (AA) Diana Diaz. Licensee (L1), Jason Johnson was called and stated authorized AA to conduct inspection and signed report.

The facility is a 2 bedroom, and 2 bathroom home and fire clearance were granted for 3 non-Ambulatory in room 1 and room 2 and 1 bedridden in room 2 for a total capacity of 4. Facility telephone number is 661-381-7203.

LPA toured the facility with AA. Facility was free from ground obstructions and odor free. Common areas were observed to have adequate seating and lighting available. A fire extinguisher was observed and had a service date of 07/10/24. Kitchen was toured and observed to have dishes, plates, and utensils. Knives will be kept locked in kitchen drawer. Refrigerator temperature maintained at 40 degrees F. Cleaning supplies was observed stored and locked under kitchen sink. LPA observed 2 day perishable and 7 day nonperishable food. Medications will be locked in hall closet. First aid kit was observed and contained all required items. Bedrooms were observed to have the required furnishing and are ready for occupancy. LPA observed an extra supply of bed linens and towels. Hot water temperature ranged between 116.1 degrees F in bathroom master bathroom and 118 degrees F in bathroom. Toilet observed operational and functional during inspection. Outside of facility toured. Exits were open and free of obstructions. LPA observed side gate to be self-latching and free debris. Smoke detectors and carbon monoxide were observed to be operational during this inspection.

Component III was conducted during today's pre-licensing visit. I have found that the applicant has met all pre-licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/30/2024
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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