<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209133
Report Date: 08/13/2024
Date Signed: 08/13/2024 02:02:33 PM

Document Has Been Signed on 08/13/2024 02:02 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:
157209133
ADMINISTRATOR/
DIRECTOR:		JOHNSON, JASONFACILITY TYPE:
740
ADDRESS:2714 GOSFORD RD #ATELEPHONE:
(661) 972-6235
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 6CENSUS: 4DATE:
08/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:House Supervisor Diana Diaz TIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 08/13/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct required Annual inspection. LPA introduce self, stated the purpose of the visit, and met with House Manager Marina De La Cruz. Administrator Jason Johnson who stated unable to attend meeting. House Supervisor Diana Diaz arrived shortly. LPA toured facility with House Supervisor. Three residents observed during inspection.

The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. Outside of facility toured and observed to be free of debris. Fire extinguisher was observed with a service date of: 6/10/24. An adequate supply of perishable and non-perishable food was observed. Temperature maintained for refrigerator at 40 degrees F and freezer at 0 degrees F. All bedrooms were toured and observed to be required furniture and adequate lighting. Bathrooms observed functional and operational. Non-skid strips and grabbed bars were observed. Hot water temperature was tested 128.6 degrees F in bathroom 1 and 127.9 degrees F in master bathroom. Medications and sharps observed kept locked in hall closet. Chemicals were observed stored and locked in the garage cabinet. Carbon monoxide and smoke detector observed operational during inspection.

A deficiency is being cited on the attached Lic 809D in accordance to California Code of Regulations, Title 22,
Division 6.

Exit Interview conducted. A copy of this report and appeal rights was provided to House Supervisor, whose signature on this form confirms receipt of this report.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 08/13/2024 02:02 PM - It Cannot Be Edited


Created By: Mai Yang On 08/13/2024 at 01:45 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: PATHWAY HOMES
FACILITY NUMBER: 157209133

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(e)(2)
87303 (e)(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C).

This requirement was not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, LPA checked and tested hot water was measured at 128.6 degree F in bathroom 1 and 127.9 degree F in the master bathroom which poses a potential health and safety risk for the person in care.
POC Due Date: 08/19/2024
Plan of Correction
1
2
3
4
Facility is to send proof of Hot water temperature measures between 105 and 120 degrees to CCL by POC date of 08/19/2024.

Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:See Moua
LICENSING EVALUATOR NAME:Mai Yang
LICENSING EVALUATOR SIGNATURE:
DATE: 08/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2024


LIC809 (FAS) - (06/04)
Page: 3 of 3