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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209217
Report Date: 08/21/2024
Date Signed: 08/21/2024 12:35:47 PM

Document Has Been Signed on 08/21/2024 12:35 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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:PATHWAY HOMESFACILITY NUMBER:
157209217
ADMINISTRATOR/
DIRECTOR:		JOHNSON, JAIMYFACILITY TYPE:
740
ADDRESS:334 MONTCLAIR STTELEPHONE:
(661) 972-6051
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 4CENSUS: 3DATE:
08/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Administrator Jason Johnson and House manager Diana TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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On 08/21/24, 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 Catalina Aquino. Administrator Jason Johnson and House manager Diana Diaz was called and arrived shortly. LPA toured facility with Administrator and House Manager. All three 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: 07/10/24. Last fire drill completed on 08/14/24. Chemicals were observed stored and unlocked under kitchen sink. Temperature maintained for refrigerator at 38 degrees F and freezer at -6 degrees F. All bedrooms were toured and observed to be required furniture and adequate lighting. Medications observed locked in hall closet. Dryer functioning and operating during inspection Bedroom was observed furnished and good lighting. Bathrooms were toured. Toilet observed functional and operational. Non-skid strips and grabbed bars was observed. Hot water temperature was tested 105.4 degrees F in bathroom hall bathroom and 105.1 degrees F in shared bathroom.

Outside of facility toured and observed to be free of debris. Side gate self-latching and self-closing. Adequate outside seatings observed available for resident. Carbon monoxide and smoke detector observed operational during inspection.

A deficiency is being cited on the attached 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 Administrator via email, whose signature on this form confirms receipt of this report.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 08/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/21/2024
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 08/21/2024 11:59 AM - It Cannot Be Edited


Created By: Mai Yang On 08/21/2024 at 11:46 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 HOMES
FACILITY NUMBER: 157209217

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87705(f)(2)
87705 (f)(2) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants.

This requirement was not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above when LPA observed at 11:04AM, cleaning chemicals stored under kitchen sink unlock accessible to residents in care this poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/22/2024
Plan of Correction
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Administrator locked under the kitchen sink. 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: 08/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/21/2024


LIC809 (FAS) - (06/04)
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