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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157208991
Report Date: 12/28/2022
Date Signed: 03/06/2023 01:30:20 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/10/2022 and conducted by Evaluator Malia Thao
COMPLAINT CONTROL NUMBER: 24-AS-20221010164309
FACILITY NAME:PATHWAY HOMESFACILITY NUMBER:
157208991
ADMINISTRATOR:JOHNSON, JASONFACILITY TYPE:
740
ADDRESS:2714 GOSFORD RD#DTELEPHONE:
(661) 735-5108
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY:6CENSUS: 4DATE:
12/28/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Elizabeth Ramos, House ManagerTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff failed to provide assistance to resident resulting in falls while in care.
INVESTIGATION FINDINGS:
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This is an amended report.
On 12/28/22 at 11:00 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a complaint inspection. LPA explained reason for inspection and was granted entry by staff. Licensee/Administrator (LIC) Jason Johnson was unavailable for the inspection but was available by telephone at which time the findings of the investigation were delivered.

Today, 3/6/23, LPA arrived at the facility unannounced to amend the investigation findings delivered on 12/28/22, as follows. LPA announced reason for visit and met with Licensee Jason Johnson.

During the investigation, LPA reviewed records and conducted interviews. Based on review, R1 had some falls at the facility however there was not sufficient evidence to prove that the falls were the result of staff not providing assistance to R1, therefore the allegation is unsubstantiated. Exit interview conducted. A copy of this report was given to Licensee Jason Johnson, whose signature confirms receipt of this report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/10/2022 and conducted by Evaluator Malia Thao
COMPLAINT CONTROL NUMBER: 24-AS-20221010164309

FACILITY NAME:PATHWAY HOMESFACILITY NUMBER:
157208991
ADMINISTRATOR:JOHNSON, JASONFACILITY TYPE:
740
ADDRESS:2714 GOSFORD RD#DTELEPHONE:
(661) 735-5108
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY:6CENSUS: 4DATE:
12/28/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Elizabeth Ramos, House ManagerTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff yelled at resident.
Resident is isolated.
INVESTIGATION FINDINGS:
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7
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13
On 12/28/22 at 11:00 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a complaint inspection. LPA explained reason for inspection and was granted entry by staff. Licensee/Administrator (LIC) Jason Johnson was unavailable for the inspection but was available by telephone. Licensee gave permission for staff to sign today's inspection report.

During the course of the investigation, LPA reviewed records and conducted interviews. Based on records review and interviews, LPA found that there was not sufficient evidence to show staff yelled at resident and resident is isolated. The above allegations are unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted via telephone with Licensee. A copy of this report was given to staff XX, whose signature confirms receipt of this report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 24-AS-20221010164309
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 HOMES
FACILITY NUMBER: 157208991
VISIT DATE: 12/28/2022
NARRATIVE
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This report was amended.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 24-AS-20221010164309
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 HOMES
FACILITY NUMBER: 157208991
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/18/2023
Section Cited
CCR
87468.2(a)(4)
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This report was amended.
87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)...residents...shall have all of the following personal rights: (4) To care, ...services that meet their individual needs ...

This requirement is not met as evidenced by:
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This report was amended.
Licensee will submit proof of a new care plan for R1 and proof of an in-service training, with roster, for all staff about R1's new care plan, to CCL by POC due date.
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This report was amended.
Based on records review and interviews, LPA found that LIC and S1 admitted to telling R1 to transfer or move by R1’s self because R1 can do it. LIC states R1 is stubborn and refuses to use the wheelchair or walker to assist R1’s self with transfers or moving about, which has resulted in falls. R1’s records show R1 has extensive assistance need for bed mobility, transfers, and movement within the residence. Which poses a potential health, safety, or personal rights risk to residents 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.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4