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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209376
Report Date: 12/10/2024
Date Signed: 12/10/2024 02:44:33 PM

Document Has Been Signed on 12/10/2024 02:44 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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:PATHWAY HOME CAREFACILITY NUMBER:
157209376
ADMINISTRATOR/
DIRECTOR:		DIAZ, DIANAFACILITY TYPE:
740
ADDRESS:416 LANSING DRIVETELEPHONE:
(661) 972-6051
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 4CENSUS: 2DATE:
12/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:33 PM
MET WITH:Diana Diaz, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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On 12/10/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct initial complaint investigation. LPA introduced self, stated the purpose of the visit, and met with House Supervisor Diana Diaz. All two residents were present during visit.

LPA toured facility with House Supervisor. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. Fire extinguisher was observed with a service date: 06/10/24. An adequate supply of perishable and non-perishable food was observed. Refrigerator temperature is maintained at 37 degrees F and freezer at 0 degrees F. At 01:05PM, cleaning supplies and chemicals stored under kitchen sink unlock. Knives stored and locked in kitchen drawer. Extra linens were observed in hall closet. All bedrooms were observed to have the required furnishings and with adequate lighting. All bathrooms were toured and observed operational during inspection. Non-skid strips and grabbed bars were observed. Hot water temperature was tested at 113 degrees F in bathroom and 113.5 degrees F in master bathroom. Outside of facility toured and observed to be free of debris. Adequate outdoor seatings available for residents. Extra cleaning chemicals observed locked in garage. Smoke detectors and carbon monoxide were observed operational during visit. Medications were observed locked in hall closet. MARs were reviewed and medications were checked. All residents’ and a sample of staff files were reviewed.



A deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22,
Division 6.

Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 12/16/24. The following updated forms were requested: Lic 308, Lic 500, Lic 610E, and current liability insurance. A copy of this report and appeal rights was provided to Administrator, whose signature confirms received of this report.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2024
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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Document Has Been Signed on 12/10/2024 02:44 PM - It Cannot Be Edited


Created By: Mai Yang On 12/10/2024 at 02:26 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: PATHWAY HOME CARE
FACILITY NUMBER: 157209376

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87309(a)
87309(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interviews, the licensee did not comply with the section cited above when LPA observed cleaning chemicals stored under the kitchen sink unlock this poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/11/2024
Plan of Correction
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Staff locked chemicals during visit. POC cleared during visit.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:See Moua
LICENSING EVALUATOR NAME:Mai Yang
LICENSING EVALUATOR SIGNATURE:
DATE: 12/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2024


LIC809 (FAS) - (06/04)
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