<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209308
Report Date: 04/06/2023
Date Signed: 04/07/2023 01:28:07 PM

Document Has Been Signed on 04/07/2023 01:28 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:
157209308
ADMINISTRATOR:JOHNSON, JONATHANFACILITY TYPE:
740
ADDRESS:414 LANSING DRIVETELEPHONE:
(661) 972-4646
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 4CENSUS: 0DATE:
04/06/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:52 PM
MET WITH:Administrator, Jonathan JohnsonTIME COMPLETED:
02:26 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Darius Williams conducted an announced pre-licensing inspection. LPA Williams met with Administrator, Jonathan Johnson and discussed the purpose of the visit.

LPA Williams and the Administrator toured the facility.

The living room was clean and in good repair. There was seating available for four residents.

LPA Williams toured two bedrooms. Each bedroom had two beds, dresser, night stands, chair, required linens, working light, and enough space to accommodate people.

Both bathrooms were clean and in good repair. Bathroom 1 had non slip strips in the shower. Bathroom 2's shower required additional non-slip strips for the front half of the shower pan (approximately 50 percent). Grab bars were present in shower and next to toilets.

Chemicals and the identified medication storage were observed behind a locked door in the hallway.

Kitchen was clean and in good repair. Faucet water temperature reflected approximately 59.2 defree Fahrenheit (F) via LPA Williams handheld thermometer. Refrigerator reflected approximately 38 degrees F and freezer reflected approximately -4 degrees F. Utensils, plates, and cook wear were present.

Smoke detector, carbon monoxide, and fire extinguisher were present and serviceable.

*Continued on LIC 809-C*
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE: DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: PATHWAY HOME CARE
FACILITY NUMBER: 157209308
VISIT DATE: 04/06/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Administrator agreed to fix the items below:

- Hot water temperature was 59.2. Regulation requires it to be between 105 to 120 degrees F. Administrator reported a utility worker will be coming out to check on the gas utility.
- Bathroom 2 non-slip strips in shower
- Working phone line
- Thermostat displayed 63 degrees F. Administrator attempted to turn on the HVAC unit. Unit would not turn on and no heat/air was blowing out of any vents.
- Add patio table, chairs, with umbrella in the backyard patio for residents.
- Facility Plan of Operation.

A follow up appointment was rescheduled for 4/19/2023.

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: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2