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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209211
Report Date: 05/12/2023
Date Signed: 05/12/2023 05:14:07 PM

Document Has Been Signed on 05/12/2023 05:14 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 HOME CAREFACILITY NUMBER:
157209211
ADMINISTRATOR:JOHNSON, JONATHANFACILITY TYPE:
740
ADDRESS:410 LANSING DRIVETELEPHONE:
(661) 836-5705
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 6CENSUS: 4DATE:
05/12/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Facility Supervisor, Jessica VasquezTIME COMPLETED:
01:57 PM
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Licensing Program Analyst (LPA) Darius Williams was presented an eviction notice regarding Resident 1, during a visit. LPA Williams met with Facility Supervisor, Jessica Vasquez and discussed the eviction notice. Administrator Jason Johnson, was present via telephone.

LPA Williams advised both parties that the eviction notice required additional information and was not valid at this time. LPA Williams informed them that a new eviction notice would have to be drafted with additional information and presented to Resident 1.

An exit interview was conducted and a copy of this report will be provided via e-mail.
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2023
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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