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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209297
Report Date: 05/22/2023
Date Signed: 05/22/2023 10:32:26 AM

Document Has Been Signed on 05/22/2023 10:32 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 ASSISTED LIVING/ WESTCHESTER GARDENSFACILITY NUMBER:
157209297
ADMINISTRATOR:JOHNSON, JONATHANFACILITY TYPE:
740
ADDRESS:2228 TRUXTUN AVETELEPHONE:
(661) 324-3091
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93301
CAPACITY: 36CENSUS: 25DATE:
05/22/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:Jonathan Johnson, AdministratorTIME COMPLETED:
10:45 AM
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On 5/22/23 at 9:33 AM, Licensing Program Analyst (LPA) Malia Thao arrived announced to conduct a follow-up Pre-licensing inspection. LPA met with Licensee/Administrator (LIC) Jonathan Johnson.

LPA observed the following corrections:
1. All fire extinguishers with service tags showing last service date of 4/28/23.
2. All toilets observed with a newly installed toilet seat/lid.
3. Sampled bathrooms observed with clean floors behind the toilets.
4. Hot water in sampled bathrooms of bedrooms #16, 18, and 12 observed within 105-120 degrees F range.
5. Room #16 observed with non-skid mat.
6. Emergency lighting observed operational.
7. Sample of rooms observed with a chair(s).
8. Sample of rooms observed with toilet paper.
9. Theft and investigative procedures observed posted.
10. Copy of Admission Agreement posted.
11. RCFE Complaint Poster (PUB 475) posted in correct size.
12. Licensee's visiting policy is posted.
13. Pre-appraisals observed completed for a sample of new residents.

All pre-licensing requirements have been met. LPA will notify CAB in Sacramento for final review prior to license being issued.

Exit interview was conducted. A copy of this report was given to Licensee Jonathan Johnson, whose signature confirms receipt of this report.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2023
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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