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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209157
Report Date: 10/21/2021
Date Signed: 10/21/2021 06:36:43 PM

Document Has Been Signed on 10/21/2021 06:36 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:
157209157
ADMINISTRATOR:JOHNSON, JASONFACILITY TYPE:
740
ADDRESS:2714 GOSFORD RD #BTELEPHONE:
(661) 972-6235
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 6CENSUS: 0DATE:
10/21/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Jason Johnson, LicenseeTIME COMPLETED:
10:45 AM
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 10/21/21 at 9:15 am, Licensing Program Analyst (LPA) Malia Thao arrived announced to conduct a Pre-Licensing inspection. LPA was granted entry and met by Licensee (LIC) Jason Johnson.

LPA observed baseboard around toilet area to be recaulked and painted, tile line adjacent to shower was re-grouted in master bath; insect droppings cleaned from sliding door frame; smoke and carbon monoxide combination detector installed, tested, and operational; kitchen exit door opening and closing with ease; all debris was removed from backyard; and floors, baseboards, walls, doors and door frames, and windows observed cleaned. Comp III completed with LIC.

All pre-licensing requirements have been met. LPA will notify CAB in Sacramento for final review prior to license being issued.

Exit interview was conducted. A copy of this report was emailed to Licensee Jason Johnson with "Read receipt" to confirm receipt of this report.
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.

LIC809 (FAS) - (06/04)
Page: 1 of 1