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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209308
Report Date: 09/25/2024
Date Signed: 09/26/2024 07:16:17 AM

Document Has Been Signed on 09/26/2024 07:16 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:
09/25/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:25 AM
MET WITH:Licensee Jason Johnson and Supervisor Diana Diaz TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 09/25/24, 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 introduce self, stated the purpose of the visit and met with Licensee Jason Johnson and Supervisor Diana Diaz.

LPA toured the facility interview with R1 whose was observed in bedroom.

A follow up case management will be conducted if necessary.

An exit interview was conducted, and a copy of this report was provided to Licensee, whose signature confirms received of this report.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2024
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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