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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 08:06:24 PM

Document Has Been Signed on 04/18/2024 08:06 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:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:18 PM
MET WITH:Miranda Wright, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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On 04/18/24, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct a case management visit based on incident reports for Resident R1. LPA was greeted by Administrator, stated the purpose of the visit and was allowed entry into the facility.

LPA requested a copy Resident R1's, Individual emergency plan, IPP and functional Behavioral Assessments. R1 is currently in the hospital under evaluation. LPA will review plans and return at a later date.

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
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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