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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200947
Report Date: 06/01/2023
Date Signed: 06/01/2023 11:56:43 AM

Document Has Been Signed on 06/01/2023 11:56 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:AIM HIGHFACILITY NUMBER:
079200947
ADMINISTRATOR:TRUCKS, CHRISTINAFACILITY TYPE:
775
ADDRESS:1336 SUNSET DRTELEPHONE:
(415) 290-7611
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY: 30CENSUS: 25DATE:
06/01/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Alberto Vega, Program CoordinatorTIME COMPLETED:
12:05 PM
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On 6/1/2023 at 11:35AM, Licensing Program Analyst (LPA), L. Hall arrived unannounced to conduct a health and safety check as a result of the department receiving a complaint. LPA met with Alberto Vega, Program Coordinator and explained the reason for the visit.

Upon arrival, LPA observed total of five (5) Clients were in the common area. Clients were doing activities, some went out in the community to the store but soon returned, then the clients ate lunch during visit.

During the health and safety check, LPA toured the building including but not limited to common areas and bathrooms. Facility is noted to be clean and in good repair and clients in care appear to be safe. There are no imminent health/safety concerns on today's date.

No deficiencies were cited today.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2023
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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