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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208994
Report Date: 11/16/2023
Date Signed: 11/16/2023 05:48:25 PM

Document Has Been Signed on 11/16/2023 05:48 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:
11/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Program Director, Diana DiazTIME COMPLETED:
12:30 PM
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Licensing Program Analyst conducted an Annual Inspection visit. LPA Williams met with Program Director, Diana Diaz and discussed the purpose of the visit. Administrator, Jason Johnson arrived at a later time.

LPA Williams toured the facility with Program Director.

The kitchen was sanitary and in good repair. There were 2 days of perishable food and 7 days nonperishable food.

The dining and living room had seats to accommodate all residents. The facility thermostat reflected approximately 75 degrees Fahrenheit (F).

LPA Williams observed resident bedrooms. The bedroom had a bed, with required linens, night stand, dresser, chairs, and working light. There was space for clients to move around and the rooms were personalized.

Two bathrooms were sanitary and in good repair. There were non-slip strip and grab bars available for resident use.

Smoke detectors and carbon monoxide detectors were present and operational. First aid kit was present and had all required items.

LPA observed medications, chemicals, and sharps to be locked and inaccessible to residents.

*Continued on LIC 809C*
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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
VISIT DATE: 11/16/2023
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The backyard had seating available for residents and there was an overhang with shaded area. There is no pool on the premises.

LPA reviewed five resident files which had documentation that was requested.

No deficiency was cited during this visit.

LPA requested the following documents be provided to the Department: Liability Insurance, LIC 500 and LIC 308.

An exit interview was conducted and a copy of this report will be provided via e-mail.
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC809 (FAS) - (06/04)
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