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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209211
Report Date: 08/13/2024
Date Signed: 08/13/2024 10:53:09 AM

Document Has Been Signed on 08/13/2024 10:53 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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:PATHWAY HOME CAREFACILITY NUMBER:
157209211
ADMINISTRATOR/
DIRECTOR:		JOHNSON, JAIMYFACILITY TYPE:
740
ADDRESS:410 LANSING DRIVETELEPHONE:
(661) 836-5705
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 6CENSUS: 5DATE:
08/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:House supervisor Elizabeth Ramos TIME VISIT/
INSPECTION COMPLETED:
10:55 AM
NARRATIVE
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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 staff Adriana Hernandez. House supervisor Elizabeth Ramos and House Manager Diana Diaz was called and arrived shortly. House Supervisor called Administrator Jaimy Johnson who stated unable to attend meeting. LPA toured facility with House Supervisor. Four 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. An adequate supply of perishable and non-perishable food was observed. Fire extinguisher was observed with a service date of: 6/10/24. Temperature maintained for refrigerator at 37 degrees F and freezer at 0 degrees F. All bedrooms were toured and observed to be required furniture and adequate lighting. Bathrooms were observed operational. Non-skid strips and grabbed bars observed in the bathroom. Toilet observed functional and operational.

Extra linens and towels observed. Hot water temperature was tested 112.6 degrees F in bathroom 1 and 113.9 degrees F in shared bathroom. Chemicals were observed stored and locked in garage. Dryer and washer observed operating during inspection. Outside of facility toured and observed to be free of debris. Adequate outside seatings observed available for resident. Carbon monoxide and smoke detector observed operational during inspection. Medications observed kept locked in facility office.

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)
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Document Has Been Signed on 08/13/2024 10:53 AM - It Cannot Be Edited


Created By: Mai Yang On 08/13/2024 at 10:34 AM
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 HOME CARE
FACILITY NUMBER: 157209211

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

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
8755(b)(28)
8755(b)(28) All food shall be protected against contamination. Contaminated food shall be discarded immediately upon discovery.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, expired canned foods, expired food, and mold was observed on canned food, which poses an immediate health and safety risk for the person in care.
POC Due Date: 08/14/2024
Plan of Correction
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Staff immediately discard the expired canned food, food and molded can. POC cleared during visit.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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)
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