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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209211
Report Date: 05/02/2022
Date Signed: 05/02/2022 02:30:16 PM

Document Has Been Signed on 05/02/2022 02:30 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 HOME CAREFACILITY NUMBER:
157209211
ADMINISTRATOR:JOHNSON, JONATHANFACILITY TYPE:
740
ADDRESS:410 LANSING DRIVETELEPHONE:
(661) 972-4646
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 6CENSUS: 0DATE:
05/02/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Jonathan Johnson, Licensee
Jaimy Johnson, Licensee
Jason Johnson, Licensee		TIME COMPLETED:
02:45 PM
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On 5/2/22 at 12:05 PM, Licensing Program Analyst (LPA) Malia Thao arrived announced to conduct a Pre-licensing inspection. LPA met with Licensees Jonathan Johnson, Jaimy Johnson, and Jason Johnson.

LPA conducted tour of the inside and outside of the facility. No obstructions observed. All bedrooms have sufficient furniture and lighting. One grab bar observed for use of toilet and shower in both hallway and master bathrooms. Non-skid strips observed for both showers. Facility set at comfortable temperature. Fire extinguisher was purchased on 2/5/22. Dishware and utensils observed. Centrally stored medication observed designated to locked file cabinet in locked office. Chemicals observed in locked storage unit in hallway. First aid kit observed complete.

The following observed will need to be brought into compliance:
1. Hot water in hallway bathroom measured at 122.1 degrees F.
2. Master bathroom entrance observed with a curtain installed, no door installed.
3. Exterior fence in backyard is missing to close off backyard for facility from other attached living units' backyard space.
4. Exterior fire exit gate observed with nail sticking out to catch gate latch. Latch observed with cotton string attached as pull string.
5. RCFE Complaint Poster (PUB 475) sign is not of appropriate size of 20" x 26".

Comp III completed. A follow up inspection to be scheduled once all above items are in compliance.

Exit interview conducted. A copy of this report was given to Licensee Jonathan Johnson, whose signature confirms receipt of this report.
SUPERVISORS NAME: Andy Xiong
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2022
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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