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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157204037
Report Date: 01/09/2024
Date Signed: 01/09/2024 05:52:02 PM

Document Has Been Signed on 01/09/2024 05:52 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:AIMES SHELLEYFACILITY NUMBER:
157204037
ADMINISTRATOR:CORTEZ, JOSEFACILITY TYPE:
735
ADDRESS:2808 SHELLEY LANETELEPHONE:
(661) 589-9992
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY: 4CENSUS: 4DATE:
01/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Administrator Anothony ArambulaTIME COMPLETED:
12:45 PM
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Licensing Program Analyst Shawna Doucette (LPA) arrived at the facility unannounced to conduct a Required Annual inspection. LPA was met by Administrator Anthony Arambula.

LPA conducted a tour inside and outside of facility. Facility observed to be clean, and at a comfortable temperature set at 72 F. Common areas were furnished well with adequate seating and lighting available. Kitchen toured, appeared clean and safe for food preparation. Food supply checked, LPA observed an adequate supply of food. Resident rooms checked and were clean. Medications were locked in a closet. LPA observed an adequate supply of linen. Hot water measured at 116.8 degrees F. Exterior tour conducted, all exits open and free of obstructions. Side gate was observed to be self-latching.

Fire extinguisher serviced on 7/06/2023. Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. Facility has a pull station fire alarm with sprinkler system. Last fire drill conducted 1/1/2024. All cleaning supplies are locked and secured in a cabinet in the garage. .

An exit interview was conducted with the Administrator and a copy of this report was provided.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2024
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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