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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209133
Report Date: 07/29/2021
Date Signed: 07/30/2021 03:14:11 PM

Document Has Been Signed on 07/30/2021 03:14 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:
157209133
ADMINISTRATOR:JOHNSON, JASONFACILITY TYPE:
740
ADDRESS:2717 GOSFORD RD #ATELEPHONE:
(661) 972-6235
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 6CENSUS: 0DATE:
07/29/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:43 AM
MET WITH:Licensee Jason JohnsonTIME COMPLETED:
01:00 PM
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On 7/30/21 at approximately 10:45 AM Licensing Program Analyst (LPA) Shawna Doucette arrived to the facility announced to conduct the Pre licensing visit. LPA Shawna Doucette met with Licensee Jason Johnson who granted LPA entry into the facility.

LPA toured facility. Common rooms have adequate furnishings and lighting. All of the resident bedrooms have all the required furnishings and adequate lighting. Bedroom #2 needs to have beds rearranged to not block exit. Hot water temperature in bathrooms measured at under 100 degrees F. LPA observed a supply of extra bed linens and personal hygiene and grooming products. Kitchen observed to have dishes, plates, utensils. Cleaning supplies are stored in a locking cabinet in garage. Medications are locked in a medication closet in hallway. First aid kit contains all the required items. A fire extinguisher is present and has a service date of 03/05/2021. Smoke detectors and carbon monoxide were operating properly.

Outside of the facility toured. No outside hazards were observed. No pools or bodies of water.

All required postings are posted. Facility phone number will be (661) 412-4002.

Component III was conducted during pre-licensing visit with Applicants.


Licensee will fix water and Bedroom #2 bed blocking door prior to being licensed.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2021
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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