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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208931
Report Date: 04/28/2022
Date Signed: 04/28/2022 12:11:11 PM

Document Has Been Signed on 04/28/2022 12:11 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 COFFEE HOUSEFACILITY NUMBER:
157208931
ADMINISTRATOR:DANIELS, LAURAFACILITY TYPE:
738
ADDRESS:6742 COFFEE RDTELEPHONE:
(661) 589-9992
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY: 4CENSUS: 3DATE:
04/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:19 AM
MET WITH:Administrator, Alexis Rutledge, Social Worker, Isaac Gomes, and Trainer, Stacy KrebsTIME COMPLETED:
12:18 PM
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On 04/28/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Alexis Rutledge Social Worker, Isaac Gomez, and Trainer, Stacy Krebs. Facility has one central entry and exit and has implemented a sign-in policy for visitors. There is 1 resident present during this inspection.

LPA toured the interior and exterior of the facility with Administrator and Social Worker. Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. LPA observed signs promoting social distancing and cough/sneeze etiquette. Social distancing is maintained in the common and dining areas. Bathrooms have trash cans with lid. Hand washing posters were observed by the bathroom sinks. Bedrooms are single occupant.

LPA checked residents’ locked medications and observed a 30-day supply. Food supply was checked and there appeared to be an adequate supply. Cleaning and PPE supplies were checked. Facility staff was observed with mask on. Residents wear masks when away from the community. Resident’s files have updated emergency contact information.

LPA is requesting the following documents be submitted to the Fresno CCL office by 05/12/2022: Current copy of Administrator certificate, Designation of Facility Responsibility, Administrator Organization, Affidavit regarding Client/Resident Cash Resources, Emergency Disaster Plan, Personnel Report, Register of Clients/Residents.

No deficiencies issued during this inspection. Exit interview conducted. A copy of this report was discussed and provided to Administrator, whose signature on this form confirms receipt of this document.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2022
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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