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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209434
Report Date: 09/25/2024
Date Signed: 09/25/2024 10:34:32 AM

Document Has Been Signed on 09/25/2024 10:34 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 HOMESFACILITY NUMBER:
157209434
ADMINISTRATOR/
DIRECTOR:		RAMOS, ELIZABETHFACILITY TYPE:
740
ADDRESS:332 S. MONTCLAIR ST.TELEPHONE:
(661) 972-6051
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 4CENSUS: 0DATE:
09/25/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Licensee Jason Johnson, Administrator Elizabeth Ramos, and Supervisor Diana DiazTIME VISIT/
INSPECTION COMPLETED:
10:40 AM
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On 09/25/24, Licensing Program Analyst (LPA) Yang arrived at the facility for an announced visit to conduct
the Pre licensing visit. LPA Yang met with Licensee Jason Johnson, Administrator Elizabeth Ramos, and Supervisor Diana Diaz.

LPA toured the facility with Licensee, Administrator, and Supervisor. The facility is a 2 bedroom, and 2 bathroom home and fire clearance were granted for 3 non-ambulatory and 1 bedridden for a total capacity of 4. The living room was clean and in good repair. There was seating available for residents. Kitchen was toured and observed to have dishes, plate, and utensils. Sharps observed locked in kitchen drawer. A fire extinguisher was observed and with a purchased date of 06/10/24. Adequate perishable food observed. Non-perishable food will be purchased prior to resident placement. Refrigerator temperature observed maintained at 32 degrees F and freezer temperature maintained at -4 degrees F. Bedrooms were toured. Each room has two beds, dresser, night stands, chair, required linens, working light, and enough space to accommodate people. Hot water temperature tested at 106.8 degrees F in shared bathroom and 109 in degrees F in hall bathroom. All bathrooms had nonskid strips in the shower with fasten grab bars present in shower and next to the toilets. Bathroom toilet observed operational. Extra linens observed in hall closet. Medications will be lock in hall closet. First aid kit was observed and contained all required items. Cleaning supplies and chemicals were observed locked under kitchen and in hall hazard closet. Outside of facility toured. Available outside seatings was observed for resident. LPA observed side gate to be self-latching. Exits were open and free of obstructions. Smoke detectors and carbon monoxide were observed operational during visit. Facility phone number will be (661)381-7203.

Component III was conducted during today's pre-licensing visit.

We have found that the applicant has met all pre-licensing requirements. LPA will submit documentation to
CAB in Sacramento for final review prior to license being issued.
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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