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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208931
Report Date: 04/18/2024
Date Signed: 04/18/2024 08:05:24 PM

Document Has Been Signed on 04/18/2024 08:05 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/
DIRECTOR:		WRIGHT, MIRANDAFACILITY TYPE:
738
ADDRESS:6742 COFFEE RDTELEPHONE:
(661) 589-9992
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY: 4CENSUS: 2DATE:
04/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:38 AM
MET WITH:Miranda Wright, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 04/18/24, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required Annual Inspection Visit. LPA was greeted by Administrator, stated the purpose of the visit and was allowed entry into the facility. Administrator on record is Miranda Wright # 6026388735 Expiration 05/18/25. Administrator certificate is observed posted on the wall.

LPA tour the facility inside and out. Facility temperature was 71 degrees F. There was one resident in care at the time of visit, residents were attending day program. Facility is a 4 bedroom 3 bathroom home. Private resident bedrooms were observed to have the required lighting and furnishings and were free from odor and free from any passageway obstruction / fire hazards. LPA observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. An emergency disaster supply was observed.

Bathrooms were toured and observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at 110 degrees F. Trash can with lid and hand washing postings were observed. Internet devices and a working phone line were observed to be available for residents in care. A supply of extra linen's and towels were observed in the laundry room.

Carbon monoxide and smoke detectors were tested and observed to be operational. Carbon Monoxide detectors are located in secondary living room, common hallway and resident bedroom hallways. A State Fire Marshall approved automatic fire sprinkler system was observed to be operational. Fire Extinguisher was observed with a service date of 01/03/24. First aid kit was observed in the medication closet and contained all required items.
(Continued on 809-C)
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: AIMES COFFEE HOUSE
FACILITY NUMBER: 157208931
VISIT DATE: 04/18/2024
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LPA observed Resident current medical assessment, Individual Performance Plans, Individual Behavioral Support Plans.

The following documents were obtained at the time if visit. LIC 500, LIC 9020, LIC 610D, Disaster Plan.

An exit interview was conducted and a copy of this report was discussed and provided to licensee. No deficiencies cited on today's visit.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
LIC809 (FAS) - (06/04)
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