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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208931
Report Date: 01/26/2023
Date Signed: 01/26/2023 02:42:36 PM

Document Has Been Signed on 01/26/2023 02:42 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:WRIGHT, MIRANDAFACILITY TYPE:
738
ADDRESS:6742 COFFEE RDTELEPHONE:
(661) 589-9992
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY: 4CENSUS: 2DATE:
01/26/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:21 PM
MET WITH:Miranda "Mandy" Wright, Administrator TIME COMPLETED:
01:30 PM
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On 01/26/23, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct a case management based on a self reported incident. LPA was greeted by administrator, stated the purpose of the visit and was allowed entry into the facility. COVID precautionary measures were taken prior to entry.

On 01/17/23, facility submitted an LIC624 - Incident report and a self reported SOC 341 for Client C1. LPA obtained copies of the SOC 341 and copy of the incident that was submitted to Kern County Sheriff's Office (KCSO) online. Reporting states the following: "C1 is an intellectually disabled adult, who was manipulated by an unknown individual via social media, to send personal information including C1's social security number. The unknown individual assisted C1 in opening multiple bank accounts. The individual attempted to order item's on C1's Amazon account, which was not authorized by C1.

Facility cross reported this incident to appropriate and required agencies that include local law enforcement - Kern County Sheriff's Office (KCSO) , Kern Regional Center, Local Ombudsman's office and Community Care Licensing.

Facility is currently working with all responsible party's involved in the care and the placement of C1. No deficiencies cited on today's visit.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2023
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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