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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206341
Report Date: 11/12/2024
Date Signed: 11/12/2024 01:13:18 PM

Document Has Been Signed on 11/12/2024 01:13 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 NOBLEFACILITY NUMBER:
157206341
ADMINISTRATOR/
DIRECTOR:		CORTEZ, JOSEFACILITY TYPE:
735
ADDRESS:5717 NOBLE STREETTELEPHONE:
(661) 589-3737
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 4CENSUS: 4DATE:
11/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:40 AM
MET WITH:Administrator, Jose CortezTIME VISIT/
INSPECTION COMPLETED:
01:27 PM
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On 11/12/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by Administrator. LPA met with Administrator, Jose Cortez. There are no clients present during today's inspection.

LPA reviewed facility records and observed the following: Resident records were observed to be complete and current. Staff files were reviewed electronically with Administrator. Medications reviewed and found to be administered as prescribed. Emergency disaster plan reviewed. Last fire drill was conducted on 11/02/2024.

Facility tour conducted with Administrator. Facility observed to be clean, and at a comfortable temperature. 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, passage ways were clear from obstructions. LPA observed an adequate supply of linen and hygiene products. Facility bathrooms toured. Hot water measured at 119.8 degrees F. Fire extinguisher last serviced on 01/15/2024. Smoke detector and carbon monoxide detector were tested and observed to be operational during today's inspection. Exterior tour conducted, all exits open and free of obstructions.

No deficiencies issued during today's inspection. Exit interview conducted. A copy of this report was discussed and provided to Administrator, Jose Cortez, whose signature on this form confirms receipt of this document.

LPA is requesting the following documents be submitted to the Fresno CCL office by 11/26/2024: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610E) Personnel Report (LIC500), Register of Facility Clients/Residents (LIC9020A), Surety Bond

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/12/2024
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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