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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209308
Report Date: 09/11/2024
Date Signed: 09/12/2024 08:31:42 AM

Document Has Been Signed on 09/12/2024 08:31 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:
157209308
ADMINISTRATOR/
DIRECTOR:		JOHNSON, JAIMYFACILITY TYPE:
740
ADDRESS:414 LANSING DRIVETELEPHONE:
(661) 972-4646
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 4CENSUS: 3DATE:
09/11/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:50 PM
MET WITH:Diana Diaz, House ManagerTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 09/11/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct visit for the purpose of checking on the health and safety of the residents in care. LPA met with House Manager (HM) Diana Diaz. Three client was present during visit.

LPA toured the facility and conducted interviews. LPA observed two residents present during inspection. R1 was not present during visit.

A follow up case management will be conducted if necessary.

An exit interview was conducted, and a copy of this report was provided to House Manager, whose signature
confirms received of this report.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2024
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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