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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157208994
Report Date: 10/21/2021
Date Signed: 10/21/2021 06:44:51 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/18/2021 and conducted by Evaluator Malia Thao
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20210518102759
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:
10/21/2021
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Jason Johnson, LicenseeTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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9
Lack of supervision.
INVESTIGATION FINDINGS:
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On 10/21/21 at 10:45 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a complaint investigation and deliver findings. LPA met with Licensee (LIC) Jason Johnson.

During the course of the investigation, LPA made observations, conducted interviews, and reviewed records. Based on observations, interviews, and record review, LPA found that staff are listed as scheduled at both facility and LIC's facility next door. LIC admits staff will go work at facility next door to help and is not barred from doing so when working alone. The above allegation is substantiated.

Deficiency is being cited based on LPA observations, interviews, and record review in accordance with the California Code of Regulations, Title 22, see LIC9099D.

Exit interview conducted. A copy of this report and appeal rights were discussed and emailed to facility's email address on record, with "Read receipt" to confirm receipt of this report.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Andy Xiong
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/18/2021 and conducted by Evaluator Malia Thao
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20210518102759

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:
10/21/2021
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Jason Johnson, LicenseeTIME COMPLETED:
01:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility has bed bugs.
INVESTIGATION FINDINGS:
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2
3
4
5
6
7
8
9
10
11
12
13
On 10/21/21 at 10:45 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a complaint investigation and deliver findings. LPA met with Licensee (LIC) Jason Johnson.

During the course of the investigation, LPA made observations, conducted interviews, and reviewed records. LPA did not observe bed bugs or evidence of bed bugs in the facility. LIC admits pest control was called for service specifically for bed bugs after staff reported via photo or video of bed bugs present in the facility. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. The above allegation is unsubstantiated.

Exit interview conducted. A copy of this report was emailed to email address on record with "Read receipt" to confirm receipt of this report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Andy Xiong
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 24-AS-20210518102759
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: PATHWAY HOMES
FACILITY NUMBER: 157208994
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/28/2021
Section Cited
CCR
87411(a)
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87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...

This requirement is not met as evidenced by:
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Licensee will submit proof of new staff schedule for each separate facility by POC due date.
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Based on observations, interviews, and record review, LPA found that staff are listed as scheduled at both facility and LIC's facility next door. LIC admits staff will go work at facility next door to help and is not barred from doing so when working alone. This poses a potential health, safety, and 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: Andy Xiong
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3