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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208994
Report Date: 07/12/2021
Date Signed: 07/12/2021 01:57:05 PM

Document Has Been Signed on 07/12/2021 01:57 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 HOMESFACILITY NUMBER:
157208994
ADMINISTRATOR:JOHNSON, JASONFACILITY TYPE:
740
ADDRESS:2714 GOSFORD RD #CTELEPHONE:
(661) 302-4728
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 6CENSUS: 5DATE:
07/12/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jason Johnson, Licensee/AdministratorTIME COMPLETED:
02:15 PM
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A Non-Compliance Conference meeting was held on 07/12/2021 at the Fresno Regional Office. The purpose of the Non Compliance Conference was to discuss recently identified issues/concerns associated with the operation of the facility. The Non-Compliance conference process was explained during this meeting.

The following were in attendance:
Jason Johnson, Licensee/Administrator
Brenda White, Regional Manager
Melinda Hoffmann, Licensing Program Manager
Sergiy Pidgirny, Licensing Program Manager
Shawna Doucette, Licensing Program Analyst
Malia Thao, Licensing Program Analyst

Licensee was provided with copies of all applicable regulations and/or Health and Safety Codes.
SUPERVISORS NAME: Andy Xiong
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2021
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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