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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209157
Report Date: 08/23/2021
Date Signed: 08/24/2021 09:31:14 AM

Document Has Been Signed on 08/24/2021 09:31 AM - 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:
157209157
ADMINISTRATOR:JOHNSON, JASONFACILITY TYPE:
740
ADDRESS:2714 GOSFORD RD #BTELEPHONE:
(661) 972-6235
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 6CENSUS: 0DATE:
08/23/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Jason Johnson, LicenseeTIME COMPLETED:
10:30 AM
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On 8/23/21 at 8:45 am, Licensing Program Analyst (LPA) Malia Thao arrived announced to conduct a Pre-Licensing inspection.

LPA toured inside and outside of facility. No obstructions observed. All bedrooms have sufficient furniture and lighting. One grab bar observed for use of toilet and shower in hallway bathroom. Non-skid strips observed for both showers. Hot water measured 110.1 degrees F. Facility set at comfortable temperature. Fire extinguisher was last serviced 3/9/21. Dishware and utensils observed. Centrally stored medication observed designated to locked hallway closet. Chemicals observed in locked storage unit in garage. First aid kit observed complete.

The following will need to be brought into compliance:
1. Master bath: Re-caulking of toilet base, replace baseboards around toilet area, and re-grout tile line adjacent to shower.
2. Bedroom #3: Clean insect droppings on complete sliding door frame.
3. Install new smoke detector and carbon monoxide detector. May be combination.
4. Kitchen: Correct door to be able to be opened and closed with ease. Door sticking at about 45 degree angle.
5. Backyard: Remove all debris: windows, used chest drawer, and stack of lumber (has nails sticking out).
6. Clean all floors, baseboards, walls, doors and door frames, and windows.

Comp III to be completed at follow-up inspection.

Exit interview conducted. A copy of this report was emailed to Licensee Jason Johnson at pathwayhomes@yahoo.com with a read receipt to confirm receipt of this report.
SUPERVISORS NAME: Andy Xiong
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2021
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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