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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208991
Report Date: 03/06/2023
Date Signed: 03/06/2023 01:29:40 PM

Document Has Been Signed on 03/06/2023 01:29 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 HOMESFACILITY NUMBER:
157208991
ADMINISTRATOR:JOHNSON, JASONFACILITY TYPE:
740
ADDRESS:2714 GOSFORD RD#DTELEPHONE:
(661) 735-5108
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 6CENSUS: DATE:
03/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:07 PM
MET WITH:Jason Johnson, LicenseeTIME COMPLETED:
01:40 PM
NARRATIVE
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On 3/6/23 at 1:07 PM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a case management - other inspection to amend the report issued on 12/28/22. LPA explained reason for inspection and met with Licensee (LIC) Jason Johnson.

LPA amended LIC9099 issued on 12/28/22 to the facility.

No deficiencies cited during this inspection.

Exit interview conducted. A copy of this report was given to Licensee Jason Johnson, whose signature confirms receipt of this report.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2023
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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