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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200947
Report Date: 01/26/2024
Date Signed: 01/26/2024 11:41:45 AM

Document Has Been Signed on 01/26/2024 11:41 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:
(925) 978-9918
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY: 30CENSUS: 15DATE:
01/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Alberto Vega, AdministratorTIME COMPLETED:
11:55 AM
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On 1/26/2024 at 9:55AM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct an annual 1-year inspection visit. LPA met with Alberto Vega, Administrator and explained the purpose of the visit. Facility's fire clearance is for twenty-seven (27) ambulatory and three (3) non-ambulatory clients.

LPA inspected the facility which included but not limited to the bathrooms, kitchen, common areas, and the outside area of the facility. LPA observed the facility to be free of odor, clean and in good repair. Outdoor space is provided and is free of hazards. There is a comfortable room temperature of 68 degrees Fahrenheit for clients in care. Grab bars were observed in bathrooms and throughout the facility. Clients bring their own lunches and snacks to facility. The hot water temperature in the shared bathroom measured 123.3 degrees. All observed toilets and hand washing stations are maintained in a safe, sanitary, operating condition. There are no bodies of water or fire safety hazards observed. Carbon monoxide and smoke detectors found to be in working order. Centrally toxins and sharp objects were locked and inaccessible to clients. Fire extinguisher last purchased 12/23/2023. Fire drill last conducted 10/5/2023. First aid kit was checked and is complete.

LPA reviewed four (4) staff files and five (5) client's files.

Continued on LIC809C.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: AIM HIGH
FACILITY NUMBER: 079200947
VISIT DATE: 01/26/2024
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Continued from LIC809.

The following forms to be updated and submitted to CCLD by 2/2/2024:
  • LIC 308 Designation of Administrative Responsibility
  • LIC 610D Emergency Disaster Plan

No deficiencies were cited during this inspection.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024
LIC809 (FAS) - (06/04)
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