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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209376
Report Date: 11/15/2023
Date Signed: 11/15/2023 03:12:38 PM

Document Has Been Signed on 11/15/2023 03:12 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:
157209376
ADMINISTRATOR:JOHNSON, JAIMYFACILITY TYPE:
740
ADDRESS:416 LANSING DRIVETELEPHONE:
(661) 972-6051
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 4CENSUS: 0DATE:
11/15/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Program Director, Diana DiazTIME COMPLETED:
12:05 PM
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Licensing Program Analyst (LPA) Darius Williams conducted an announced Pre-Licensing visit. LPA met with Program Director, Diana Diaz.

Tour began in the living room. There was seating available to accommodate all residents. There facility thermostat reflected 70 degrees Fahrenheit (F). A phone was present and operational with an active line.

LPA observed two bedrooms, which each had two beds, with all required linens, chairs, night stands, lamp, and dressers.

There are two bathrooms available for resident use. Both bathrooms had non-slip strips in the showers and grab bars for resident use.

The kitchen is clean and sanitary. The refrigerator temperature reflected 37 degrees F and freezer 0 degrees F.

There is a patio with seating and shade for resident use. There is no pool on the premises.

First aid kit was present with all required items. Dual smoke/carbon monoxide detector was present and operational.

There were no corrections observed during the visit.

Program Director waived Component III, as it was reviewed during the Pre-License of another facility.

At this time no license has been issued. LPA will forward report to the Central Applications Bureau for further review.
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2023
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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