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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209216
Report Date: 08/10/2022
Date Signed: 08/10/2022 11:55:29 AM

Document Has Been Signed on 08/10/2022 11:55 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:
157209216
ADMINISTRATOR:JOHNSON, JAIMYFACILITY TYPE:
740
ADDRESS:336 MONTCLAIR STTELEPHONE:
(661) 972-6051
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 4CENSUS: 0DATE:
08/10/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jaimy Johnson, Administrator
Jason Johnson, Licensee		TIME COMPLETED:
10:50 AM
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On 8/10/22 at 10:00 AM, Licensing Program Analyst (LPA) Malia Thao arrived announced to conduct an announced prelicensing inspection. LPA met with Administrator Jaimy Johnson and Licensee Jason Johnson, and granted entry.

LPA measured hot water in hallway bathroom at 118.2 degrees F, facility phone is in service, baseboards around toilet area in both hall and master bathroom observed with caulking between baseboards and wall, cabinet under kitchen sink observed as designated location for disinfectants and cleaning solutions that will be kept inaccessible to residents, and LPA received updated facility yard sketch.

All licensing requirements have been met. LPA will notify CAB of prelicensing inspection completion. CAB will finalize application and submit license to Licensee once the application process has been completed.

Exit interview conducted. A copy of this report was given to Administrator Jaimy Johnson, whose signature confirms receipt of this report.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2022
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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