157209435-1-30-2026-24-AS-JDUE-DQTSEV-20260130124923

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 157209435
Report Date: 01/30/2026
Date Signed: 01/30/2026 12:49:40 PM

Document Has Been Signed on 01/30/2026 12:49 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME:	PATHWAY HOMES		FACILITY NUMBER:	157209435
ADMINISTRATOR/ DIRECTOR:	JOHNSON (LOPEZ), JAIMY		FACILITY TYPE:	735
ADDRESS:	330 S MONTCLAIR ST		TELEPHONE:	(661) 972-6051
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93309
CAPACITY: 4		CENSUS: 2	DATE:	01/30/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:56 AM
MET WITH:	Administrator Adriana Hernandez		TIME VISIT/ INSPECTION COMPLETED:	01:00 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

On 01/30/26, Licensing Program Analyst (LPA) J. Duarte and Licensing Program Manager (LPM) A. Walton, arrived unannounced to conduct the required Annual inspection. LPA introduced self, stated the purpose of the visit, and met with Administrator (AD) Adriana Hernandez. (AD) Diana Diaz arrived shortly after. LPA toured the facility with AD Diaz.

The facility was observed to be at a temperature of 72 degrees F, clean, in good repair, and no passageway obstructions were observed. The living room has sufficient seating for residents. The kitchen was toured and LPA observed an adequate supply of perishable and non-perishable food. An emergency supply of food was also observed in the kitchen cabinets. The facility stores kitchen knives in a locked kitchen cabinet. A fire extinguisher was observed in the kitchen, with a service date of 05/23/25.

Both bedrooms were toured and observed to have beds, dressers, and adequate lighting. Bathrooms were observed operational, with non-skid strips and grabbed bars observed for the showers and toilets. The hot water measured at 106 degrees F. Extra linens and towels observed stored in a hall closet.

Chemicals and detergent were observed stored and locked under the kitchen sink. The facility has a dryer and washer in the hallway closet. Outside of the facility toured and observed to be free of debris with adequate seating available for residents.

The carbon monoxide/smoke detector were observed operational during inspection. Medications observed kept locked in hallway closet. Medication and MARs were reviewed and medication logs reflect medication is being administered as prescribed. A first aid kit is also stored with the medication. Resident files and hospice care plans were reviewed. Upon review, it was found that the facility does not have a Hospice Waiver to retain hospice residents. A sample of staff files were reviewed and observed to have required documentation.

Continued in LIC 809C.

NAME OF LICENSING PROGRAM MANAGER: Serigy Pidgirny
NAME OF LICENSING PROGRAM ANALYST: Jimmy Duarte
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/30/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: PATHWAY HOMES	FACILITY NUMBER: 157209435
	VISIT DATE: 01/30/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued from LIC 809.

Deficiencies are being cited on the attached LIC 809D pages, in accordance to California Code of Regulations, Title 22,Division 6.

An exit Interview was conducted. A copy of this report and appeal rights were provided to AD, whose signature on this form confirms receipt of this report.

Adult Residential Facility (ARF):

· LIC 308 Designation of Facility Responsibility
· -as applicable: LIC 309 Administrative Organization
· -as applicable: LIC 400 Affidavit Regarding Client/Resident Cash Resources
· -as applicable: LIC 402 Surety Bond
· LIC 500 Personnel Report
· LIC 610D Emergency Disaster Plan For Adult Residential Facilities
· LIC 9020 Register of Facility Clients/Residents
· Copy of current Administrator Certificate
· Alternate contact information including name, telephone number, & email address.

Please submit the above forms/information to Fresno CCL by: 2/6/26.

NAME OF LICENSING PROGRAM MANAGER: Serigy Pidgirny
NAME OF LICENSING PROGRAM ANALYST: Jimmy Duarte
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/30/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026

LIC809 (FAS) - (06/04)

Page: 4 of 4

Document Has Been Signed on 01/30/2026 12:49 PM - It Cannot Be Edited

Created By: Jimmy Duarte On 01/30/2026 at 12:24 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 HOMES	FACILITY NUMBER: 157209435
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/30/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

85075.1(a)(1)

85075.1 HOSPICE CARE (a) A licensee shall be permitted to retain terminally ill clients who receive hospice services from a hospice agency or to accept terminally ill persons as clients if they are already receiving hospice services from a hospice agency and would continue to receive those services without disruption after becoming a client, when all of the following conditions (1) through (7) are met: (1) The licensee has received a facility hospice care waiver from the Department This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above when the facility retained a resident who is receiving hospice services without a hopsice care waiver from the Department, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 01/31/2026
	Plan of Correction
1 2 3 4	Licensee agrees to submit a written statement detailing the steps the facility will take to esnure the requirements for section 85075.1 are met to the Fresno CCLD Office by the POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Serigy Pidgirny
NAME OF LICENSING PROGRAM MANAGER:

	Jimmy Duarte
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/30/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026

LIC809 (FAS) - (06/04)

Page: 3 of 4